Evidence based clinical supervision

A high level of research evidence has revealed that the ultimate result of an effective clinical supervision is improved patient care and experience. Therefore when measuring the success of clinical supervision researchers have focused on establishing the extent to which there was an improvement in patient or client outcome.  Patient or client care and experience are impacted negatively when new or trainee clinicians in different fields fail to receive an adequate supervisory intervention. According to Kilminster and Jolly (2010), there is evidence of patient death, mental health deterioration, and dissatisfaction associated with less supervisory interventions of junior doctors in surgery, counselling and obstetrics and pediatrics. Though some trainees claim that they benefit from a high level of experience gained by a lack of supervision, more evidence seems to prove that patient care suffers when new or trainee clinical professionals are left unsupervised. This is so because, in absence of clinical supervision, a new or trainee medical professional including surgeons, psychiatrists, counsellors, pediatricians, and others may provide low standards of care because they may not have learned best practices through clinical supervision.

A research study on the impact of direct supervision of new or trainee physicians in the US revealed that there is a direct effect of clinical supervision on patient care. Though the research studies acknowledged weaknesses in the study design, physicians reported experiencing great positive changes in the patient outcome as a result of trainee clinical supervision (Farnan et al., 2012). This shows that supervision of new or trainee counsellor has significant positive impact on patient outcome. Through supervision new or trainee counsellor are likely to gain more knowledge and skills in patient diagnosis, assessment, treatment and most importantly view patients as valuable. 

Phases of clinical supervision

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Another study examining the effect clinical supervision on the quality of care was carried out in five Harvard teaching hospitals. In this research study, data on patient outcome was collected on varied types of patients such as those suffering from abdominal pain, chest pain, mental health issues, head trauma and vaginal bleeding (Kilminster and Jolly, 2010). The research study was carried for seven months, and a total number of 3667 patients with the above-listed types of sicknesses were given questioners to complete with the help of their family members who brought them to the hospital. The patients were expected to fill the questionnaire before leaving the hospital and would be scheduled for a follow-up interview within ten days. The trainee physicians, as well as supervisors, were not aware of the purpose of the study and this eliminated bias or the level of error. The research study aimed to collect data on trainee compliance on the process of care guidelines and patient or client satisfaction, outcome and report on problems with the care service received. The results of the study revealed that clinical supervision had a greater impact on patient or client satisfaction and outcome especially in the cases where the trainees were new and had less experience (Kilminster and Jolly, 2010). Also, further research studies have provided evidence on the effectiveness of supervision of psychotherapy.  For instance, a research study by Jungers and Gregoire (2013) revealed the quality of supervision relationships affects the quality of patient outcome in psychotherapy. In this research study, 237 psychotherapy clients were given an opportunity to conduct self-rate in regards to the improvement of their mental health. The findings of the survey revealed that the psychotherapy clients rated themselves high in the instances where the supervisor’s and trainee hypothetical or theoretical orientations were in harmony. 

Clinical supervision in education

Another measure of the success of clinical supervision is determining its effectiveness on the trainee or supervisee. Several empirical studies have examined the impact of supervising a trainee medical professional based on the trainee self-assessment reports or supervisor’s perspective. However, it is critical to note that supervisors’ perspective on successful supervision may differ from that of the trainee. If the two parties work together as outlined earlier in this literature review to improve the supervisory relationship, it is more likely that they will both be satisfied by the supervision process and it will have a positive impact n the trainee skills, experience, and self-evaluation. According to Kilminster and Jolly (2010), clinical psychologists (counsellors) who were closely supervised by observing, assisting and receiving feedback from their supervisors gained more skills and rapidly as compared to those who were not closely supervised.

During clinical supervision, especially in the fields such as counselling, psychotherapy, nursing, clinical psychology, and teaching, both the trainee counsellor and the supervisor should develop positive behaviour. Behaviour affects the supervision process and ability of the trainee to learn. For instance, trainees can hinder their chances to learn from clinical supervision if they portray behaviours of showing that they are competent as this will impede the possibility of asking questions and consulting the supervisor (Ward and House, 2008).

Conclusion

Clinical supervision is essential in the training and career development process of new or trainee clinical professional in almost all medical fields. Clinical training improves patient outcome and helps new or trainee physicians to gain more skills and experience through observing, receiving guidance, receiving feedback and assisting more experienced clinical professionals as they diagnose, assess, treat and provide care and support to patients or clients. As discussed in the literature review the supervisor should select an appropriate model of clinical supervision depending on the experience of the trainee. Both the trainee and supervisor should also strive to have the right attitude and exhibit positive behavior because these determine the learning process and the outcome of the clinical supervision process. 

References

Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of Clinical Supervision (4thed.). Needham Heights, MA: Allyn & Bacon. 

British Association for Counselling and Psychotherapy (BACO). (2016). Good practice Overview: Research and literature overview of supervision within the counseling professions.

Carroll, M. M. (2011). Counselling supervision. Sage.

Farnan, J. M., Petty, L. A., Georgitis, E., Martin, S., Chiu, E., Prochaska, M., & Arora, V. M. (2012). A Systematic review: the effect of clinical supervision on patient and residency education outcomes. Academic Medicine, 87(4), 428-442.

Glickman, D. C. (2010). The Development Approach To Supervision: Supervisors Should Recognize Stages Of Professional Development And Treat Teachers As Individuals. 

Jungers, C. & Gregoire J. (2013). The Counselor's Companion: What Every Beginning Counselor Needs to Know

Kilminster S. M. ; Jolly B. C. (2010). Effective Supervision In Clinical Practice Setting. Literature Review. Medical Education: 9th Cambridge Conference; 34:827;840

Kilminster, S., Cottrell, D., Grant, J., ; Jolly, B. (2007). AMEE Guide No. 27: Effective educational and clinical supervision. Medical Teacher, 29(1), 2-19.

Smith, K. L. (2009). A Brief Summary of Supervision Models. Retrieved From: Http://Www.Marquette.Edu/Education/Grad/Documents/Brief-Summary-Of-Supervision-Models.Pdf

;Stoltenberg, C. D. ; Mcneill, B. W. (2011). IDM Supervision: An Integrative Developmental Model For Supervising Counselors And Therapists, Third Edition. Routledge;

Townend, M., Iannetta, L., ; Freeston, M. H. (2012). Clinical supervision in practice: A survey of UK cognitive behavioural psychotherapists accredited by the BABCP. Behavioural and Cognitive Psychotherapy, 30(04), 485-500.

Ward, C. C., ; House, R. M. (2008). Counselling Supervision: A Reflective Model. Counselor Education and Supervision, 38, 23-33.