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Supervision
Supervision is a key feature of professional development in a wide range of professions.
The Royal College of Psychiatrists sees it as
the ‘single most important ingredient of
training’ for senior house officers and registrars.
Supervision is obviously perceived by those
responsible for standard setting in psychiatry as a key activity. But what constitutes
good and effective supervision?
Adult learners bring a wide range of past
experience, learning abilities and styles, and motivation to their learning. Training has
to manage a constant tension between a respect for their autonomy as mature adult learners
and the need to specify learning objectives.
Some knowledge of educational theory with respect to styles and processes of learning is
helpful for supervisors. If supervisors can conceptualise different stages in the
trainee’s thinking about problems and assess which stage the trainee is using, this
assessment can be shared with the trainees during supervision. Trainees may be at different stages of conceptualisation for
different types of problem depending on past experience. Trainees who have been relatively
senior in other fields before coming to psychiatry may be attempting to use higher levels
of thinking without the necessary relevant experience to base this on. Supervisors may
have to shift quickly from relative direction to relative non-direction within one
supervision session depending on which type of problem is being discussed.
Supervisors will also have to think about the their skills in appraising others and their
capacity to listen to trainee’s presentations, provide positive feedback where
appropriate and criticise constructively. Such skills have not always been taught as a
routine part of training. Potential supervisors may need further training in these areas.
Supervision will always be different for each trainer/trainee pair. Nevertheless, it
cannot be effective without a clear structure and without explicit aims and objectives.
One hour of 1 to 1 supervision per week is usually
seen as the irreducible minimum of supervision and should happen at a regular time and in
a fixed place each week.
The time should be protected as far as is possible from interruptions by bleeps/telephone
calls etc. The first one or two supervision sessions in a placement should include a
review of the trainee’s prior training with a view to identifying important gaps in
experience and the particular opportunities available in the forthcoming placement.
This process will be helped if the trainee keeps a log book of experience throughout
training which can be used to plan future training needs. Thereafter supervision sessions
should be trainee led as far as is possible. Trainees should be encouraged to come to
supervision with an agenda of topics that they wish to be discussed. The exact frequency
of discussion of any one case and the depth of that discussion will depend on the
particular trainee’s experience.
Record Keeping
Trainees should bring to supervision an up to date
list of their current cases and the case notes of any casethat they wish to discuss.
Trainers should also make notes about cases which are discussed so that they can
a) monitor if any cases have not been discussed for too long and b) remind themselves of
previous discussions
Although difficulties within the supervision relationship should be resolved internally as
far as is possible, there must be a way for trainees who are having difficulties to have
access direct to the College Tutor.
Trainees must have supervision in the following areas:
1.Clinical
Theoretical and practical management of cases. In particular helping trainees to integrate
theoretical and research knowledge into clinical practice.
Management of caseload and setting of learning objectives and priorities
In depth supervision of particular cases
Supervision for specific therapeutic modalities e.g. individual psychodynamic
psychotherapy
2.Teaching & Research
Teaching skills training
Discussion of the learning and supervision process
Appraisal skills and the supervision of others
Research methodology and research project supervision
3.Management & Administration
Management skills training and provision of knowledge regarding medical politics and NHS
structures
Issues concerned with the functioning of and the working with multidisciplinary teams
4.Pastoral
Personal guidance and support. In particular, the supervisor has an obligation to bring up
personal issues if he/she thinks they are affecting their trainee’s capacity to work.
5. Careers guidance Most supervisors should be able
to provide some supervision in these areas even if they do not feel able to provide
comprehensive training.
Thus the local membership course or academic programme may provide a teaching skills
course but the consultant supervisor may still be able to provide supervision of a
particular teaching engagement during a placement. Similarly most schemes provide separate
research supervisors for trainees but this should not stop consultants pointing out and
discussing relevant research when in relation to clinical work.
Additional training experiences
In addition to the one hour per week of supervision, there are a number of other
activities which contribute to the supervision process. Trainers should endeavour to
provide some or all of the following during placements depending upon the nature of the
placement and the needs of the trainee:
opportunities for the trainee to observe the
consultant working in a variety of different settings including attendance at meetings or
conferences with the consultant where appropriate
live supervision of the trainee either individually or as part of a family therapy team
observation of one session with a particular case as. a way of providing more detailed
supervision of complex cases
joint work with the trainee
opportunities for all of the above with other members of the team who have different
skills to the consultant supervisor
Additional Reading about Supervision
Bools C. & Cottrell D. (1990) Future child and
adolescent psychiatrists: a further survey of senior registrar training. Psychiatric
Bulletin. 14, 611-615.
Herriot P, Bhui K. & Lelliott P. (1994) Supervision of trainees. Psychiatric Bulletin.
18,474476
Joint Committee on Higher Psychiatric Training (1998) Handbook. 8th Ed Royal College of
Psychiatrists: London
Kingsbury S. & Allsopp M. (1 994) Direct consultant supervision of higher trainees in
child and adolescent psychiatry. Psychiatric Bulletin. 18, 225-229.
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Version 4.0
October 2000