Clinical Supervision of Counselors-in-Training Working with Suicidal Clients: A Grounded Theory Investigation

The purpose of the current study was to generate an emergent theory of the process of counselor supervision for counselor trainees who work with suicidal clients. The researchers explored perspectives of five counselor supervisors, each of whom served as director of the counseling clinic/practicum training lab at his or her respective counselor preparation program. The emergent theory was titled Supervision for Suicidal Clients as an Immediate, Versatile Collaboration Between Counselor Trainees and Counselor Supervisors and captured participants' experiences of supervision as a complex, evolving process focused on client welfare and promoting counselor trainee growth.     

Understanding trust as an essential element of trainee supervision and learning in the workplace

Clinical supervision requires that supervisors make decisions about how much independence to allow their trainees for patient care tasks. The simultaneous goals of ensuring quality patient care and affording trainees appropriate and progressively greater responsibility require that the supervising physician trusts the trainee. Trust allows the trainee to experience increasing levels of participation and responsibility in the workplace in a way that builds competence for future practice. The factors influencing a supervisor’s trust in a trainee are related to the supervisor, trainee, the supervisor–trainee relationship, task, and context. This literature-based overview of these five factors informs design principles for clinical education that support the granting of entrustment. Entrustable professional activities offer promise as an example of a novel supervision and assessment strategy based on trust. Informed by the design principles offered here, entrustment can support supervisors’ accountability for the outcomes of training by maintaining focus on future patient care outcomes.     

6/ In Vivo Rotation:

Effective teaching of psychotherapy generally involves elements of didactic instruction, immediate supervision following trainee's therapy hours and some method by which trainees may observe and evaluate their own therapy behaviors. The in vivo rotation model of teaching psychotherapy includes, these aspect, as well as the opportunity for the live observation of the supervisor and fellow trainees as therapists. Each therapy-supervision session includes a 45-minute individual therapy session with observers present, a 30-minute group discussion of the therapy with the client observing, and a 15-minute debriefing between therapist and client. Supervisor, trainee and client responses suggest that this model is an intense and productive learning experience.     

Effects of Experience on Counselor Trainee's Needs

The current investigation was designed to assess the validity of Stoltenberg's (1981) conceptualization that counselor trainees' needs change as a function of a complex developmental process. It was hypothesized that as trainees develop over time (i.e.. more education, more counseling and supervision experience) there should be a progressive shift in their training/supervision needs. Results of a series of pre-planned (a priori) contrasts suggest that regardless of whether development is defined in terms of age, education, counseling experience, or supervision experience, trainees demonstrate a tendency to change their perceptions of their overall training/ supervision needs. Supervisor imposed structure and direct supervisor feedback were identified as the two individual needs most susceptible to change. Implications and limitations of the current investigation, as well as-suggestions for future research, are discussed.     

Portfolio learning for foundation doctors: early feedback on its use in the clinical workplace

CONTEXT: A learning portfolio was developed to support the development of trainee doctors piloting Foundation Programme prototypes across the Northern Deanery in 2004 and 2005. Trainee doctors and their educational supervisors were surveyed about their experiences of using the portfolio in the clinical workplace. METHODS: The evaluation consisted of semi-structured interviews with trainee doctors and supervisors, followed by postal questionnaire surveys in 2004 and 2005. Quantitative and qualitative data were triangulated to identify core findings. RESULTS: Questionnaires were returned from 182/305 (60%) trainee doctors and 104 out of 179 (58%) educational supervisors. The portfolio was felt to be a 'good idea' by 55% supervisors and 48% trainees. Trainees' perceptions of the educational value of the portfolio remained consistently low over 2 surveys and they described a sense of 'burden', whereby they identified problems in workload and usability and in gaining feedback on performance. However, positive trainee attitudes towards the portfolio were significantly correlated with greater perceived educational benefits (r = 0.855, P < 0.001). DISCUSSION: Learning portfolios are now an integral part of Foundation Programme training but this evaluation suggests that many trainee doctors and educational supervisors are yet to be convinced of their educational value. Gaining multi-source feedback, a substantial component of trainee doctors' portfolios, impacts on the wider clinical team and presents a significant challenge to trainees. Educational supervisors continued to rely on feedback from clinical colleagues, rather than portfolio evidence, to monitor trainee doctors' development. Such factors may serve to disengage trainees with the portfolio process by overshadowing any perceived educational gains.     

The Fifth International Interdisciplinary Conference on Clinical Supervision

Doctoral students in counselor education and supervision programs take a course specific to clinical supervision as part of their doctoral course work. The transition from supervisee to supervisor occurring during this course can be challenging, as it is frequently the first time that students are asked to provide supervision to counselors in training. The purpose of this qualitative research was to gain information about the process of doctoral students' development from supervisees into supervisors. Significant themes emerged from the data related to the transition of becoming supervisors: the importance of creating the supervisory relationship and the need for further supervisory skills.     

Unsent Letters:

This paper presents an auxiliary tool to be used in social work supervision to help field work trainees to elaborate their feelings regarding their relationships with the client. The phenomenon of emotional blockages in worker-client relationships IS familiar to agency supervisors and teachers of field work. A technique for teaching trainees in field work to deal with difficulties of thts kind has been developed by the author. This technique consists in a written exercise in which the trainee composes a personal letter to the client that addresses itself to the problems in their relationship. These letters are not sent but used in supervision sessions for the benefit of the trainee.     

The workload of trainees in general practice

During their first training period in general practice the authors felt that they did not encounter the balanced workload which is the foundation for learning to be a GP. Previous studies confirmed the existence of differences in overall and specific workload between trainees and trainers. From their own experience and from the relevant literature they addressed several factors which might affect the workload of trainees. A study was undertaken to determine differences in workload between trainees and trainers, and to investigate whether certain characteristics of practice and of trainees affect the workload of trainees. Details of surgery consultations with 34 trainee-trainer partnerships were recorded in the north of the Netherlands over 2 weeks. Questionnaires were filled in by trainers, trainees and practice assistants from these 34 general practices. The total number of contacts recorded was 10,103. It was found that trainees see fewer elderly and female patients, less chronic and oncological conditions, but more minor illnesses. They see only 30% of patients with problem behaviour. Factors that influence the trainees' workload, as compared to their trainers' are: list size; selection in the allocation of patients; trainee's experience prior to starting the training stage, and the trainee's sex. Except for problem behaviour, trainees generally see a cross-section of their trainer's practice population. Selection would provide a more balanced workload for trainees.     

Supervisor Development

ABSTRACT

This study examined the influence of experience (time-served) and training (formal instruction) on supervisory stance, supervisory emphases, and self-efficacy Current thinking (Hess, 1987; Watkins, 1993) suggests that, as supervisors develop they show more support to supervisees and demonstrate higher levels of self-efficacy and are less critical and dogmatic. Supervisors (n = 60) completed a measure of supervisory emphasis and identified thoughts they would convey to a trainee they had observed on videotape. Experience and training were positively associated with changes in supervisors' self-efficacy Multivariate analyses indicated that training, but not experience, was associated with more supportive, less critical, and less dogmatic thoughts. Neither experience nor training was associated with two measures of supervisory emphasis. Thl results of this study suggest that more supportive, less critical, and less dogmatic approach to supervision are a result of specific training in supervision. Further, it would appear that experience alone is not sufficient to enhance a supervisor's development.     

What is effective supervision and how does it happen? A critical incident study

OBJECTIVES: To identify the key features of supervision from the perspectives of educational supervisors and specialist registrars. DESIGN: Critical incident study. Telephone interviews were conducted with selected informants representing a range of specialties. The sample comprised educational supervisors with an identified interest in supervision, specialist registrars and GP trainees in the Yorkshire region. RESULTS: Educational supervisors and specialist registrars were generally agreed on what constitutes effective supervision: direct supervision was seen as very important. Educational supervisors and specialist registrars had very different concerns in relation to ineffective supervision: specialist registrars were concerned with inadequate supervision whilst educational supervisors were concerned with failures in direct supervision and poorly performing trainees. Supervision practices varied between specialties; in this study there seemed to be particular problems in anaesthesia, medicine and paediatrics. CONCLUSIONS: Direct supervision and the quality of the supervisory relationship are key to effective supervision. There is a need for clear guidance on supervision and the establishment of appropriate procedures and mechanisms to resolve difficulties relating to inadequate supervision for trainees and performing trainees. Insufficient numbers of supervisors have received training in supervision.     

Self-entrustment: how trainees’ self-regulated learning supports participation in the workplace

Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees’ learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees’ development, and to explore supervisor’s role herein. We conducted a qualitative non-participant observational study in seven general practices. During two days we observed trainee’s patient encounters, daily debriefing sessions and educational meetings between trainee and supervisor and interviewed them separately afterwards. Data collection and analysis were iterative and inspired by a phenomenological approach. To organise data we used networks, time-ordered matrices and codebooks. Self-regulated learning supported trainees to increasingly perform independently. They engaged in self-regulated learning before, during and after encounters. Trainees’ activities depended on the type of medical problem presented and on patient, trainee and supervisor characteristics. Trainees used their sense of confidence to decide if they could manage the encounter alone or if they should consult their supervisor. They deliberately used feedback on their performance and engaged in reflection. Supervisors appeared vital in trainees’ learning by reassuring trainees, discussing experience, knowledge and professional issues, identifying possible unawareness of incompetence, assessing performance and securing patient safety. Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees’ increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees’ self-regulated learning.     

Peer Supervision in Counselor Training

Clinical supervision is widely recognized as critical to professional development of both practitioners and trainees. Yet, adequate clinical supervision may not be readily available to many helping professionals due to a lack of clinical supervisors with expertise, time, and interest necessary for providing supervision on a regular basis. Sharing a peer supervision relationship with a colleague can be a viable alternative or supplement to receiving supervision from an "expert" supervisor and can offer a variety of benefits not usually provided though traditional supervision. This paper provides an overview of peer supervision and presents the results of two studies of a peer supervision model in counselor education.     

Supervising the child care counselor: A cognitive developmental model

A cognitive developmental model of counselor supervision was used to create a curriculum specific to the challenges facing supervisors in residential treatment settings for aggressive/assaultive youth. A significant body of research indicates that higher levels of cognitive development predict successful functioning in areas related to counseling and supervision, including greater empathic communication, more autonomy and interdependence, and more flexible counseling and teaching methods. Evaluations of the model were positive; supervisors reported feeling rejuvenated and more confident about providing supervision. The 14-week program model and curriculum are described, and implications for further application in the child care field are explored.     

Developing skilled doctor–patient communication in the workplace: a qualitative study of the experiences of trainees and clinical supervisors

To inform the development of recommendations to facilitate learning of skilled doctor–patient communication in the workplace, this qualitative study explores experiences of trainees and supervisors regarding how trainees learn communication and how supervisors support trainees’ learning in the workplace. We conducted a qualitative study in a general practice training setting, triangulating various sources of data to obtain a rich understanding of trainees and supervisors’ experiences: three focus group discussions, five discussions during training sessions and five individual interviews. Thematic network analysis was performed during an iterative process of data collection and analysis. We identified a communication learning cycle consisting of six phases: impactful experience, change in frame of reference, identification of communication strategies, experimentation with strategies, evaluation of strategies and incorporation into personal repertoire. Supervisors supported trainees throughout this process by creating challenges, confronting trainees with their behaviour and helping them reflect on its underlying mechanisms, exploring and demonstrating communication strategies, giving concrete practice assignments, creating safety, exploring the effect of strategies and facilitating repeated practice and reflection. Based on the experiences of trainees and supervisors, we conclude that skilled communication involves the development of a personal communication repertoire from which learners are able to apply strategies that fit the context and their personal style. After further validation of our findings, it may be recommended to give learners concrete examples, opportunities for repeated practise and reflection on personal frames of reference and the effect of strategies, as well as space for authenticity and flexibility. In the workplace, the clinical supervisor is able to facilitate all these essential conditions to support his/her trainee in becoming a skilled communicator.     

A critical evaluation of the validity and the reliability of global competency constructs for supervisor assessment of junior medical trainees

Supervisor assessments are critical for both formative and summative assessment in the workplace. Supervisor ratings remain an important source of such assessment in many educational jurisdictions even though there is ambiguity about their validity and reliability. The aims of this evaluation is to explore the: (1) construct validity of ward-based supervisor competency assessments; (2) reliability of supervisors for observing any overarching domain constructs identified (factors); (3) stability of factors across subgroups of contexts, supervisors and trainees; and (4) position of the observations compared to the established literature. Evaluated assessments were all those used to judge intern (trainee) suitability to become an unconditionally registered medical practitioner in the Australian Capital Territory, Australia in 2007–2008. Initial construct identification is by traditional exploratory factor analysis (EFA) using Principal component analysis with Varimax rotation. Factor stability is explored by EFA of subgroups by different contexts such as hospital type, and different types of supervisors and trainees. The unit of analysis is each assessment, and includes all available assessments without aggregation of any scores to obtain the factors. Reliability of identified constructs is by variance components analysis of the summed trainee scores for each factor and the number of assessments needed to provide an acceptably reliable assessment using the construct, the reliability unit of analysis being the score for each factor for every assessment. For the 374 assessments from 74 trainees and 73 supervisors, the EFA resulted in 3 factors identified from the scree plot, accounting for only 68 % of the variance with factor 1 having features of a “general professional job performance” competency (eigenvalue 7.630; variance 54.5 %); factor 2 “clinical skills” (eigenvalue 1.036; variance 7.4 %); and factor 3 “professional and personal” competency (eigenvalue 0.867; variance 6.2 %). The percent trainee score variance for the summed competency item scores for factors 1, 2 and 3 were 40.4, 27.4 and 22.9 % respectively. The number of assessments needed to give a reliability coefficient of 0.80 was 6, 11 and 13 respectively. The factor structure remained stable for subgroups of female trainees, Australian graduate trainees, the central hospital, surgeons, staff specialist, visiting medical officers and the separation into single years. Physicians as supervisors, male trainees, and male supervisors all had a different grouping of items within 3 factors which all had competency items that collapsed into the predefined “face value” constructs of competence. These observations add new insights compared to the established literature. For the setting, most supervisors appear to be assessing a dominant construct domain which is similar to a general professional job performance competency. This global construct consists of individual competency items that supervisors spontaneously align and has acceptable assessment reliability. However, factor structure instability between different populations of supervisors and trainees means that subpopulations of trainees may be assessed differently and that some subpopulations of supervisors are assessing the same trainees with different constructs than other supervisors. The lack of competency criterion standardisation of supervisors’ assessments brings into question the validity of this assessment method as currently used.     

Learning in the crucible of supervision: Experiences of trainee psychotherapists in India

Trainee perspectives about supervision were examined in the relatively unexplored landscape of psychotherapy training and development in India. Ninety-four trainee therapists drawn from eight centers completed a questionnaire, Development of Psychotherapists–Trainee Background and Process Forms, at the end of training. Results indicated significant relationships between supervision satisfaction and indices of stressful work involvement, experiences in therapy sessions with clients, and perceived professional development and growth among trainees. Qualitative analysis of narratives captured both the perceived benefits and inadequacies in their experience of supervision. The findings are discussed in the context of clinical and cultural realities in training frameworks in India.     

Training Master's Level Counseling Students in the Fundamentals of Clinical Supervision

Although the helping professions have traditionally viewed clinical supervision as a doctoral level responsibility, a survey of nationally accredited counselor education programs found that a majority of site supervisors held a Master's degree as the tenninal degree. Therefore, an argument can be made for delivery of training in the fundamentals of clinical supervision to advanced students in a counselor education Master's program. This paper describes such a training component at one university and the outcomes of training including advantages, disadvantages, and potential pitfalls.     

Digital Video Documentation as Evidence of Clinical Skill Acquisition

Video recordings have become requirements for the assessment and recording of the consulting skills module of the MRCGP examination and surgical skill modules for the post FRCS hand diploma examination. Previous research has shown that the knowledge and judgement skills needed by trainees to achieve operative competence can be reliably assessed using structured checklists. However evaluation of surgical competency should also include technical skills, which have been difficult to document adequately and transparently. There is now evidence demonstrating that surgeons can discriminate between the video recordings of a competent and non‐competent trainee. Like those of previous researchers our findings indicate that intra‐operative video monitoring enables an objective and permanent recordable assessment of the a trainees skill level whilst completing the checklist after a particular procedure. Video evidence can also be distributed widely to assessors outside the trainee's locale.     

Assessment of competence and progressive independence in postgraduate clinical training

Context At present, competency‐based, outcome‐focused training is gradually replacing more traditional master–apprentice teaching in postgraduate training. This change requires a different approach to the assessment of clinical competence, especially given the decisions that must be made about the level of independence allowed to trainees. Methods This study was set within postgraduate obstetrics and gynaecology training in the Netherlands. We carried out seven focus group discussions, four with postgraduate trainees from four training programmes and three with supervisors from three training programmes. During these discussions, we explored current opinions of supervisors and trainees about how to determine when a trainee is competent to perform a clinical procedure and the role of formal assessment in this process. Results When the focus group recordings were transcribed, coded and discussed, two higher‐order themes emerged: factors that determine the level of competence of a trainee in a clinical procedure, and factors that determine the level of independence granted to a trainee or acceptable to a trainee. Conclusions From our study, it is evident that both determining the level of competence of a trainee for a certain professional activity and making decisions about the degree of independence entrusted to a trainee are complex, multi‐factorial processes, which are not always transparent. Furthermore, competence achieved in a certain clinical procedure does not automatically translate into more independent practice. We discuss the implications of our findings for the assessment of clinical competence and provide suggestions for a transparent assessment structure with explicit attention to progressive independence.     

Role Patterns in Group Supervision

Abstract

An analysis was made of 22 supervision groups in two psychotherapy training programmes at different levels. Its main focus concerned role patterns based on self-image ratings and changes over time. The results showed no significant differences between the two categories of supervisees, whereas the differences between the supervisors and the supervisees, independent of level of training, were highly significant. The results indicate that it is just as difficult to find one's voice and role in a supervision group at an advanced as at a basic level. For the supervisors the result was interpreted in terms of their roles in relation to the supervisees and the aim of the supervision.