Effective supervision in clinical practice settings: A literature review

Context Clinical supervision has a vital role in post-graduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective. Purpose To review the literature on effective supervi-sion in practice settings in order to identify what is known about effective supervision. Content The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervi-sion; skills and qualities of effective supervisors; and supervisor training and its effectiveness. Conclusions The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important fac-tor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for super-vision can be a problem. Trainee behaviours and atti-tudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and meth-odologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice