Learning in vivo

The enabling and ensuring of supervision

Supervision generally entails frequent meetings between the supervisor and student. The student reports on her/his clinical activities and the supervisor discusses what is reported. The supervision often mirrors the therapeutic process. However, the supervisor varies the aim and may use supervision either for teaching or for assessment. Supervision may either be individual or in groups (GAP, 1987). Morton-Cooper and Palmer (2000) state that in order to appreciate the richness and diversity of supervision it is sensible to review the meaning of the traditional roots of supervision. They point out both ensuring and enabling categories in the discourse about supervision. The ensuring function or form of supervision is about ‘getting the job done’ (p. 141) and relates to supervisory management. Another type of supervision, provides an enabling function or form, namely ‘independent supervision’, which is freer from organisational influences but still affected by organisational pressures and constraints. In literature ‘independent supervision’ is also called ‘consultancy, professional supervision or non-managerial supervision’ (p. 141). In addition to categories of supervision, Morton-Cooper and Palmer (2000) also points out styles of supervision, which is how the supervision is carried out. See Figure 3 for a ‘family tree’ of categories and styles of supervision. Tutorial supervision is about facilitating learning and has nothing to do with the execution of work. Training supervision relates to the placement of the student, where the supervisor has some responsibility for the student’s work. It is a trainer/clinical teacher and trainee focus. Peer supervision is a mutually beneficial relationship of collegial learning, support and feedback. Consultancy or professional supervision refers to qualified practitioners and the focus is on mentoring and enabling, rather than ensuring. There has initially been suspicion in both the social work and nursing fields about clinical supervision.

Morton-Cooper and Palmer (2000) review the development of clinical supervision and the theorising about it. They summarised three overlapping tasks that emerged, namely formative or developmental; normative or assessment; and restorative or refreshment and creativity. The first is about skills development and improving understanding, as well as growing the supervisee’s abilities, resulting in professional and personal growth. The second is about ensuring ethical practice and monitoring of standards; and the last about sharing of emotions and recharging energies.

Flemming and Steen (2004) point out that there is a significant collection of publications about supervision in general and also specific to clinical professions. Milne (2004) states that clinical supervision served for many years as foundation for clinical practice. Supervision not only fulfils an important role in training, but also to maintain quality in clinical practice and to ensure that, in the interest of clients, practitioners are suitably fit to practice.

Flemming, I. & Steen, L. 2004. Supervision and clinical psychology: theory, practice and perspectives. Hove: Brunner-Routledge.

GAP: Group for the advancement of psychiatry. 1987. Teaching psychotherapy in contemporary psychiatric residency training. New York: Brunner/Mazel.

Milne, D. 2004. Foreword. In Flemming, I. & Steen, L. 2004. Supervision and clinical psychology: theory, practice and perspectives. Hove: Brunner-Routledge.

Morton-Cooper, A. & Palmer, A. 2000. Mentoring, preceptorship and clinical supervision: a guide to professional roles in clinical practice. 2nd edition. London: Blackwell Science.

Development from rule-based to context-based behaviours

The acquisition of skills, according to Andrews and Burruss (2004), is a developmental process, a movement from rule-based behaviours to context-based behaviours. Six stages of development are identified. The table below illustrates the description of Andrews and Burruss (2004) about the progressive development from rule-based behaviours to context-based behaviours. Rules gradually become subliminal, integrated with intuition and tacit knowledge emerges.

Andrews and Burruss (2004) argue that residents should be exposed to a variety of ways of assessing patients, diagnosing and planning of treatment. This is possible through supervisor contact with several clinicians, in different clinical settings and exposure to a spread of patients across the continuum of disease severity. They substantiate their argument by pointing out that learning theory suggests that repetition (multiple learning ways and methods), as well as timely feedback and acceptance of responsibility for one’s actions together contribute to learning effectiveness. Assessment is further an important form of learning. Four levels of assessment are encouraged, namely (a) the recollection of facts, principles and theories; (b) the ability to solve problems and describe procedures; (c) demonstration of skill in a controlled setting; and (d) real practice. These four levels are alternatively referred to as knows, knows how, shows how and does (Andrews and Burruss, 2004, p. 14). The four levels provide a framework for resident learning and assessment. The overt act of assessment or measuring brings about greater awareness. And therefore improves learning. In this regard Andrews and Burruss (2004) further point out that the American Council for Graduate Medical Education in September 1997 shifted the focus from assessing the potential of programmes to measuring the actual success.

Andrews, L.B. & Burruss, J.W.B. 2004. Core competencies for psychiatric education, defining, teaching and assessing resident competence. Washington, DC: American Psychiatric Publishing.