dissertation on clinical supervision

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Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review

David a. snowdon.

1 School of Allied Health, La Trobe University, Bundoora, VIC 3086 Australia

3 Allied Health Clinical Research Office Eastern Health, Level 2/5 Arnold Street, Box Hill, VIC 3128 Australia

Sandra G. Leggat

2 School of Public Health, La Trobe University, Bundoora, VIC 3086 Australia

Nicholas F. Taylor

Associated data.

The datasets used and analysed during the current review are available from the corresponding author on reasonable request.

To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience.

Databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience.

Seventeen studies across multiple health professions (medical ( n  = 4), nursing ( n  = 7), allied health ( n  = 2) and combination of nursing, medical and/or allied health ( n  = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation ( n  = 1) and psychological symptom severity ( n  = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience.

Conclusions

Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies found a direct effect on patient health outcomes, when provided to mental health professionals clinical supervision may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. There was no association found between clinical supervision and the patient experience.

Review Registration

CRD42015029643 .

Electronic supplementary material

The online version of this article (10.1186/s12913-017-2739-5) contains supplementary material, which is available to authorized users.

Rationale/objectives

As part of the process of ensuring quality of care, clinical supervision has been widely implemented throughout health services [ 1 – 3 ]. Many studies have conceptualised clinical supervision of health professionals as senior clinicians overseeing and guiding the practice of less experienced clinicians [ 1 , 2 , 4 ]. Therefore, for the purpose of this systematic review clinical supervision was defined as ‘the provision of guidance of clinical practice for qualified health professionals by a more experienced health professional’ [ 1 , 2 , 4 ]. Clinical supervision is a professional development activity where the less experienced clinician can utilise the knowledge and experience of their supervisor, to address any gaps in knowledge or skill set and thereby improve their own clinical performance and patient quality of care [ 1 , 2 , 4 ].

Contemporary definitions of quality of care include three components: care that is clinically effective, care that is safe and care that provides a positive experience for patients [ 5 ]. Care that is clinically effective refers to providing beneficial interventions at the right time to the right patients, and includes measures of process and patient health outcomes; care that is safe reduces and controls the risk of patient harm; and the patient should be the focus of health care intervention to ensure that their experience is tailored to their needs [ 6 ].

When investigating the effectiveness of a professional development activity, such as clinical supervision, it is important that the effect on quality of care is measured [ 7 ]. The effects of clinical supervision of health professionals on patient safety have been established in a recent systematic review. In this systematic review, which investigated the effects of experienced health professionals guiding the practice of less experienced professionals, the authors concluded that clinical supervision is associated with a reduced risk of adverse patient outcomes (e.g. mortality) during high risk, invasive procedures such as surgery [ 8 ]. The authors of another systematic concluded that clinical supervision of medical residents may be beneficial at improving residents’ clinical skills, competency and adherence with protocols, and reducing patient complications [ 9 ]. However, patient health outcomes and patient experience were not evaluated, and the results cannot be generalised to supervision of all health professionals. Therefore, little is known about the effect of clinical supervision on effectiveness of care and patient satisfaction for all health professionals, including medical, nursing and allied health professionals.

The main aim of this systematic review was to investigate the effect of clinical supervision of health professionals on the effectiveness of patient care and the patient experience.

Protocol and registration

This systematic review has been reported with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting of systematic reviews and meta-analyses [ 10 ] and has been registered prospectively in the PROSPERO database (registration number: CRD42015029643).

Eligibility criteria

To be eligible, studies had to meet the following criteria: (1) investigated clinical supervision of qualified, registered or postgraduate trainee health professionals; (2) measured effectiveness of care utilising either measures of process (e.g. compliance with practice guidelines) or patient health outcomes (e.g. body structure, body function, activity, participation and quality of life measures) OR investigated patient experience with healthcare services (3) investigated a model of clinical supervision where the supervisor had more experience/expertise than the supervisee and involved supervision of clinical practice; (4) included a control group or historical comparison of health professionals who did not receive supervision or received less supervision; (5) were written in English.

Studies were ineligible if they met any of the following criteria: (1) investigated the effects of undergraduate student or entry level clinical supervision; (2) investigated the effect of clinical supervision on the performance of the clinical supervisor; (3) measured the effect of clinical supervision utilising only environmental outcomes (e.g. use of social supports) or patient safety outcomes (4) measured quality of care utilising therapist self-reported perception (5) investigated supervision of simulated patient care scenarios; (6) investigated the effects of clinical supervision of non-health care professionals; (7) investigated a peer supervision model. Inclusion/exclusion criteria ensured that studies fulfilled the definition of clinical supervision, utilised in a previous systematic review, as ‘the provision of guidance of clinical practice for qualified health professionals by a more experienced health professional’ [ 1 , 2 , 4 , 8 ], and that outcomes provided data to address the review aims.

Information sources

From the earliest available date until 11th April 2015 the electronic databases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched. Database searching was supplemented by hand searching reference lists of included studies and citation tracking using Google scholar.

The concept of intervention was searched using the following key words: supervis*, mentor*, debrief* and reflective practice. The concept of outcomes was searched using the following key words: patient outcomes, clinical outcomes, client outcomes, patient care, quality of care, patient experience, adherence and compliance. Key words and synonyms for each concept were combined with the ‘OR’ operator. The concepts of supervision and outcome were combined with the ‘AND’ operator. An example search strategy for the Medline database is provided in an additional file (see Additional file  1 ).

Study selection

One reviewer (DS) screened the articles by title and abstract utilising the eligibility criteria. Another reviewer (NT) screened the first 200 articles by title and abstract to check there was consistency in the application of the eligibility criteria. Agreement between the reviewers was reported with the kappa statistic (κ) and if κ < 0.75, the second reviewer screened a further 200 articles until acceptable agreement could be reached. Full text copies of articles that were not definitely excluded on title and abstract were retrieved for detailed examination. The two reviewers then independently reapplied the eligibility criteria on all full text copies. Uncertain cases were discussed by the reviewers to achieve consensus.

Data collection process

Pre-designed spread sheets were used to extract data on participants, healthcare interventions, supervision interventions and outcomes. The primary outcomes reflective of the effectiveness of care and patient experience dimensions of quality of care [ 5 ] were patient health outcomes, process measures including therapist compliance with guidelines/protocols relating to patient management, and measures of patient experience [ 11 – 15 ]. Patient health outcomes of interest were body structure, body function, activity, participation and health-related quality of life measures but not environmental outcomes, such as social supports, or patient safety outcomes, such as mortality, adverse event/complications, failure to treat and re-admission.

Supervision interventions were classified as: direct supervision of clinical practice, debriefing/reflective practice, and a combination of both direct supervision and debriefing/reflective practice [ 8 ]. Direct supervision refers to supervision of clinical practice where the supervisor is personally present, either face-to-face or using a communication device, during the occasion of service and has the potential to immediately influence patient care [ 16 , 17 ]. Debriefing/reflective practice refers to supervision of clinical practice that occurs after patient contact and requires the supervisee to critically reflect on their clinical performance prior to any alteration in patient care [ 18 ].

Supervision was also described in terms of the frequency of supervision and the clinical practice that was supervised. Supervised clinical practice was classified as: supervision of general practice; supervision of a procedure or treatment technique; or supervision of a specified area of clinical practice.

Methodological quality in individual studies

Studies were critically appraised for methodological quality using the Medical Education Research Study Quality Instrument (MERSQI) [ 19 ]. The MERSQI is a 10-item quality assessment tool that reflects 6 domains of study quality with a score range of 5–18 for total score [ 19 ]. A MERSQI score of 11 or higher was interpreted as a study of higher quality [ 20 ]. All studies were independently assessed by two reviewers (DS and NT). Inter-rater agreement was recorded and expressed with κ. Any disagreements between reviewers were resolved through discussion.

Synthesis of results

Odds ratios (OR) of dichotomous events and standardised mean differences (SMD) for continuous measures were calculated from measures of compliance with process and patient outcome data. Where studies were sufficiently homogenous in terms of participants, supervision interventions, therapeutic interventions and outcomes, a meta-analysis of dichotomous and/or continuous outcomes was planned utilising the inverse variance method and random-effects model [ 21 ]. If combining data were not appropriate due to clinical heterogeneity results were synthesised descriptively.

The database search yielded 19,623 records. Ninety-five articles were retrieved for full text review following application of the eligibility criteria to title and abstract. Agreement between reviewers for screening the first 200 articles was very good (κ = 0.91, 95%CI 0.73 to 1.00). Fourteen studies fulfilled the inclusion criteria when applied to full texts. Nineteen records were identified for full text review from reference lists of included articles and citation tracking. Three of these articles fulfilled the inclusion criteria, hence the final yield was 17 studies (Fig.  1 ). Agreement between reviewers for screening full text articles was very good (κ = 0.88, 95%CI 0.74 to 1.00).

Article selection process

Study characteristics & methodological quality within studies

Of the 17 studies included in this systematic review: six investigated patient health outcomes of 1746 patients [ 22 – 27 ]; 14 investigated process of care measures for 38,483 episodes of patient care [ 24 – 37 ]; and three studies investigated the health care experience of 1856 patients [ 25 , 35 , 38 ]. Five studies investigated direct supervision [ 25 , 31 , 33 – 35 ], six studies investigated debriefing/reflective practice [ 22 – 24 , 26 – 28 , 38 ] and five studies investigated a combination of direct supervision and debriefing/reflective practice [ 29 , 30 , 32 , 36 , 37 ]. Four studies investigated clinical supervision of medical professionals [ 25 , 28 , 34 , 35 ], seven studies investigated clinical supervision of nursing professionals [ 23 , 29 – 32 , 37 , 38 ], two studies investigated clinical supervision of allied health professionals [ 22 , 24 ] and three studies investigated supervision of a combination of health professions [ 26 , 27 , 33 , 36 ]. Clinical supervision was conducted weekly in three studies [ 25 , 26 , 28 ], fortnightly in two studies [ 23 , 30 ] and monthly in four studies [ 29 , 32 , 33 , 37 ]. Four studies did not report frequency of supervision sessions [ 34 – 36 , 38 ] and two studies reported supervision sessions occurring following a clinical event/consultation [ 24 , 27 ]. The quantity of supervision sessions was reported in two studies with participants receiving 40 h of supervision in one study [ 31 ] and 8 sessions in another [ 22 ]. Clinical supervision was predominantly provided for a specific area of clinical practice ( n  = 9) [ 22 , 23 , 29 – 34 , 37 ] or a procedure/treatment technique ( n  = 5) [ 24 , 26 – 28 , 36 ], while clinical supervision of general practice was investigated by fewer studies ( n  = 3) [ 25 , 35 , 38 ].

The mean MERSQI score for included studies was 13.1 (κ = 0.68, 95%CI 0.57 to 0.80), with 16 studies scoring 11 or higher. Three studies utilised a randomised controlled trial design [ 22 , 24 , 37 ], eight studies utilised a single group, pre-test post-test design [ 27 – 33 , 36 ], two utilised a retrospective cohort design [ 34 , 35 ] and four studies utilised a prospective cohort design with either concurrent or historical control [ 23 , 25 , 26 , 38 ]. One study utilised both a concurrent (between hospital) and historical (within hospital) control; for this review we analysed the data from the historical control [ 26 ]. A table outlining study characteristics is provided in an additional file (see Additional file  2 ).

Results of individual studies

Due to clinical heterogeneity no meta-analyses were completed.

Patient health outcomes

Three of the six patient health outcome studies investigated the effects of reflective supervision of mental health professionals on patient health outcomes [ 22 – 24 ]. Two studies found that patients managed by mental health professionals who participated in reflective practice, had a lower severity of psychological symptoms than patients managed by unsupervised professionals [ 22 , 23 ]. The third study found that reflective supervision of counsellors had no significant effect on patient substance abuse [ 24 ].

The three remaining studies investigated the effect of direct supervision of outpatient medical professionals [ 25 ] and reflective supervision of a multi-disciplinary medical emergency response team [ 26 , 27 ]. Reflective supervision of a multidisciplinary team providing cardiopulmonary resuscitation (CPR) for adult patients with cardiac arrest was not associated with an improved neurologic outcome [ 26 ]. In contrast, supervision of a multidisciplinary team providing CPR for paediatric patients was associated with an improved neurologic outcome [ 27 ]. Outpatients, presenting with a range of conditions including cardiac, gastrointestinal, pulmonary and renal, managed by directly supervised medical professionals did not have significantly greater health outcomes compared to those managed by unsupervised professionals [ 25 ] (Table  1 ).

Effect of supervision on patient health outcomes

bold text, P  < .05

N/S non-significant

a insufficient data provided to calculate SMD/OR

Process of care

Reflective supervision of health professionals significantly improved their performance of CPR [ 26 – 28 ]. There were significant improvements in the quality indicators of compression rate [ 26 – 28 ], compression depth [ 26 – 28 ] flow fraction [ 26 – 28 ], pre-shock pause [ 26 , 28 ], post-shock pause [ 26 , 28 ], incomplete release [ 26 ], ventilation rate [ 28 ] and delivery of appropriate shocks [ 28 ]. Additionally, one study found that clinical supervision increased the percentage of CPR attempts that were performed within recommended guidelines [ 27 ].

Studies investigating clinical supervision of health professionals delivering care in African health settings, found positive results for improved care processes [ 29 – 33 ]. Compared to historical controls, the introduction of a clinical supervision intervention improved: (1) the delivery of anti-retroviral therapy by medical and nursing professionals [ 31 , 33 ]; (2) performance of procedures that aim to reduce mother-to-child transmission of HIV [ 30 ]; and (3) adherence to nursing care guidelines in the management of antenatal [ 29 ], childhood [ 29 , 32 ] and adult illness [ 29 ]. Two studies utilised a direct supervision model [ 31 , 33 ] and three studies, a combination of direct and reflective supervision [ 29 , 30 , 32 ].

Two studies found that direct supervision of medical residents improved their compliance with guidelines for the management of patients requiring emergency care [ 34 , 35 ]. Similar results were not found in an outpatient setting, where direct supervision of interns and residents had no impact on the process of care [ 25 ]. One cluster randomised controlled trial found that a combination of direct and reflective supervision improved intra-partum and post-partum nursing care in Indian health centres [ 37 ]. While another study investigating the effect of combined direct and reflective supervision of medical, nursing and allied health professionals, found improved adherence to acceptability and repeatability criteria for performance of spirometry [ 36 ].

A randomised controlled trial found that reflective supervision, with a focus on motivational interviewing techniques, had no effect on counsellor adherence to motivational interviewing strategies when compared to usual practice supervision [ 24 ].

Compliance with procedures was assessed by observation of clinical practice in two studies [ 29 , 32 ], review of audiotape in one study [ 24 ], medical record review or analysis of routinely collected data in eight studies [ 25 , 30 , 31 , 33 – 37 ] and defibrillators/monitors with detectors in three studies investigating the quality of CPR [ 26 – 28 ] (Table  2 ).

Effect of supervision on process measures

Patient experience

None of the three studies investigating the effect of clinical supervision of health professionals found a positive effect for patient satisfaction [ 25 , 35 , 38 ] (Table  3 ).

Effect of supervision on patient experience

Findings from 14 studies and 38,483 episodes of patient care indicate that clinical supervision of health professionals is associated with a significant improvement in the performance of some processes of care. This finding predominantly applies to improving processes in the performance of CPR through the application of reflective supervision; and medical/nursing care in African health settings through the application of supervision with a direct supervision component. The majority of studies that found a positive impact on process of care utilised a model of clinical supervision that included direct supervision. Studies that investigated a model of reflective supervision in the performance of process of care that also had access to real time feedback on clinician performance also found an improvement in process of care. Therefore, an accurate representation of clinical performance may be essential to improving process of care. The effects of clinical supervision on patient health outcomes and patient experience were investigated by six and three studies respectively, which was less than the 14 studies that investigated the impact of clinical supervision on performance of process of care. Clinical supervision of mental health professionals may be associated with a reduction in psychological symptoms for individuals with a mental health illness. Clinical supervision of health professionals in a small number of studies did not demonstrate any effect on patient experience.

Given our focus on the effectiveness of care, improvements in process measures are only meaningful if the process measure is associated with improved patient outcomes [ 12 ]. Ideally, clinical supervision should be utilised to produce a change in process of care, where the process has been demonstrated to produce improved patient health outcomes. For example, two studies included in this review implemented clinical supervision to enhance the practice of the integrated management of childhood illness guidelines, which have been shown to reduce mortality in African children under five years of age [ 29 , 32 , 39 ]. Both studies found a significant improvement in the process of care. Therefore, if the measures of process are indicative of compliance with evidence-based guidelines, improvement in practice will benefit patients. Health professionals have commonly reported that a lack of organisational support, resources and knowledge are three of the primary barriers to the uptake of evidence-based practice [ 40 , 41 ]. Clinical supervision can address these barriers, providing clinicians with the support, resources and direction they require to enhance their uptake of evidence-based practice. Further research is required to investigate the effectiveness of clinical supervision as an implementation strategy compared to other strategies that have been shown to improve clinical performance, such as audit and feedback [ 42 ].

Direct supervision may be more useful in producing effective change in process of care than reflective supervision, as direct supervision allows for (1) greater levels of interaction between the supervisor and supervisee, and (2) a more accurate representation of clinical performance [ 43 ]. The majority of studies ( n  = 9) included in this review that found clinical supervision had a positive effect on process of care outcomes, utilised a model of clinical supervision where the supervisee’s clinical practice was directly supervised. However, three studies included in this review demonstrated that improvements in process of care can be achieved using a less direct model of clinical supervision, if accurate information on supervisees’ performance of care processes can be obtained via other means [ 26 – 28 ]. All three studies utilised an electronic device that provided real-time feedback on a clinician’s performance of CPR. Therefore, the decision whether to choose a direct or reflective model of supervision may depend on the clinical task being supervised and whether an accurate measure of clinician performance can be obtained without directly supervising clinical performance. When supervising a clinical task that cannot be accurately measured with an electronic device, direct supervision appears to be the most effective model to facilitate the provision of feedback, adapted to the supervisee’s needs, which is an important component of effective clinical supervision [ 44 – 46 ].

Another common attribute of supervision interventions that found positive effects for process of care is that the focus of supervision was to improve a clinical procedure/treatment technique ( n  = 4) or to improve practice in a specific area of practice ( n  = 7). Supervision of general practice could understandably be quite diverse and the focus of such supervision may be too broad to produce a change in health professional behaviour. In comparison, supervision that focuses on a particular standard of clinical practice allows both the supervisor and supervisee to direct their attention towards development of a skill set that will have an impact on clinical practice. Further research is required to establish the effect of supervision of general practice compared to supervision of a specific clinical area or procedure.

Similar to other forms of health professional education, such as conferences, workshops and rounds, clinical supervision has a greater effect on process of care than patient health outcomes [ 47 , 48 ]. However, our review did find evidence to indicate that clinical supervision of mental health professionals may reduce psychological symptoms for patients diagnosed with a mental illness [ 22 , 23 ]. Mental health professionals, including social workers, psychologists and specialist nurses, acquire the skills required to facilitate clinical supervision in their undergraduate and postgraduate studies, and have widely adopted the practice of clinical supervision and perceive clinical supervision as an effective tool for the development of their clinical practice [ 49 , 50 ]. Therefore, mental health professionals possess the skills required to facilitate the development of fellow colleagues and the receptiveness required to utilise clinical supervision for their personal skill development.

Findings from this review have broadened our understanding of the effects of clinical supervision on quality of care. Clinical supervision has been found to be associated with improved medical resident adherence to guidelines in the inpatient setting [ 9 ]. Our results not only support this association but, through analysis of a further 13 studies, support the use of clinical supervision to improve process measures in nursing, allied health and medical professionals across both inpatient and community settings. Additionally, a lack of evidence to support a direct relationship between clinical supervision and patient health outcomes identifies an opportunity for further investigation. Lastly, this review mirrors the findings of a prior review that investigated the effects of clinical supervision on patient safety, by highlighting the importance of a direct supervision component in achieving changes in health professional behaviour that can impact on quality of care [ 8 ].

There are several limitations that need to be considered when interpreting the results of this review. First, only two studies [ 24 , 37 ] investigating the effects of clinical supervision on process of care utilised a randomised controlled design. While it is difficult for studies investigating medical education to randomise participants, without adequate randomisation there is increased risk of bias in interpretation of the results [ 51 ]. However, MERSQI scores of the included studies averaged ≥11 indicative of a higher quality study, even without the randomised control. Second, most of the studies included in this review measured process of care by reviewing a patient medical record documentation. While this is a convenient method, the information obtained is only as accurate as the available documentation [ 12 , 52 ]. Alternatively, process of care was measured by direct observation of patient care in two studies [ 29 , 32 ]. This provides an accurate depiction of the process of care but also introduces the possibility of observer bias. Finally, due to the heterogeneity of the studies included in this review, there are several questions that still remain unanswered in regards to clinical supervision and its operationalisation. Specifically, this review included studies that investigated supervision of a wide range and experience of health professionals, who were supervised in the performance of clinical duties or procedures that were diverse across the studies. Therefore, it is still unknown 1) which health professional benefits most from clinical supervision and at what level of experience; 2) which clinical duties or procedures are most influenced by clinical supervision; and 3) who should provide the clinical supervision. Furthermore, a limitation of many of the included studies in this review was the lack of operationalisation of clinical supervision. Clearer descriptions of the participants, quantity and content of clinical supervision will enable health professionals to better determine the model of clinical supervision that is associated with improved quality of care.

Clinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies demonstrated a direct effect on patient health outcomes, clinical supervision of mental health professionals may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. No association was found between clinical supervision of health professionals and the patient experience dimension of quality of care.

Additional files

Medline search strategy. Example of the search strategy used to search the Medline database. (DOCX 15 kb)

Summary table of included studies. Table outlining the characteristics of studies included in this review [ 22 – 38 ]. (DOCX 45 kb)

Acknowledgements

Not applicable.

This review was supported by an Australian Government Research Training Program Scholarship.

Availability of data and materials

Authors’ contributions.

DS made substantial contributions to conception and design, data acquisition, data analysis and interpretation of data. NT and SL made substantial contributions to conception and design, data analysis and interpretation of data. DS, NT and SL have been involved in drafting the manuscript and revising it for important intellectual content. All authors read and approved the final manuscript.

Ethics approval and consent to participate

Consent for publication, competing interests.

The authors declare that they have no competing interests.

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Contributor Information

David A. Snowdon, Phone: 61 422 764 579, Email: eman.nodwons@divad .

Sandra G. Leggat, Email: [email protected] .

Nicholas F. Taylor, Email: [email protected] .

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Theses and Dissertations

The role of training in clinical supervision on clinician supervisory competency and supervisory self-efficacy.

Rachel A. Vaughn , Saint John's University, Jamaica New York

Date of Award

Document type.

Dissertation

Degree Name

Psychology (Ph.D.)

First Advisor

Mark Terjesen

Second Advisor

Tamara Del Vecchio

Third Advisor

Raymond DiGiuseppe

To date, clinical supervision training in professional psychology has focused more on theoretical models for training the supervisee and has been lacking in science. This single-case study investigated the impact of participating in a clinical supervisor training program on supervisory competency and supervisory self-efficacy. Doctoral psychology graduate students participated in a three-month training program. During the training, the students participated in weekly meta-supervision sessions, received monthly opportunities for skill practice, and attended four didactic sessions. Data was collected at four time points. Rating of supervisory competency was measured by self-reports from participants using the Supervision Adherence and Guidance Evaluation (SAGE) “supervisee cycle” and rating of supervisory self-efficacy was measured using the Clinical Supervision Self-Efficacy Scale (CSSES). Additionally, the clinical faculty that facilitated the metasupervision sessions completed the “supervisor cycle” of the SAGE. Lastly, blind raters watched participant video responses submitted during the training to provide additional ratings of supervisory competency. Three visual analyses were used to examine whether a casual relation exists between participation in clinical supervision and training program. Repeated measures ANOVA examined clinically and statistically significant changes in supervisory competency determined by the SAGE and CSSES for each participant at each of the 4 time points. The clinical supervisor training program had a statistically significant effect on supervisory competencies and supervisory self-efficacy based on supervisory trainee ratings. Clinical faculty ratings indicated similar results regarding supervisory competencies. Blind rater observations of supervisory competency skills showed the clinical supervisor training program had a statistically significant effect in one area of supervisory competency. This has implications for professional psychologist by establishing an evidence-based model of clinical supervision training for graduate programs to consider as part of their curriculum. It will also help ensure that graduating psychologist have an opportunity to increase their supervisory competency and supervisory self-efficacy before becoming supervisors in the field. Future investigations that scientifically prove the relationship between increasing supervisor competency and client outcomes would be significant.

Recommended Citation

Vaughn, Rachel A., "THE ROLE OF TRAINING IN CLINICAL SUPERVISION ON CLINICIAN SUPERVISORY COMPETENCY AND SUPERVISORY SELF-EFFICACY" (2023). Theses and Dissertations . 588. https://scholar.stjohns.edu/theses_dissertations/588

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• Research article
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• Published: 22 August 2019

Empirical research in clinical supervision: a systematic review and suggestions for future studies

• Franziska Kühne   ORCID: orcid.org/0000-0001-9636-5247 1 ,
• Jana Maas 1 ,
• Sophia Wiesenthal 1 &
• Florian Weck 1  

BMC Psychology volume  7 , Article number:  54 ( 2019 ) Cite this article

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Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse.

Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision.

The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective.

Conclusions

In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research.

Trial registration

PROSPERO; CRD42017072606 , registered on June 20, 2017.

Peer Review reports

Although in psychotherapy training and in profession-long learning, clinical supervision is regarded as one of the major components for change in psychotherapeutic competencies and expertise, its evidence base is still considered weak [ 1 , 2 , 3 ]. Clinical supervision is currently considered a distinct competency in need of professional training and systematic evaluation; however, theoretical developments and experience-driven practice still seem to diverge, and “significant gaps in the research base” are evident ([ 1 ], p. 88).

Definitions of supervision underline different aspects, whereas a lack of consensus seems to impede research [ 1 ]. Falender and Shafranske [ 4 , 5 ] stress the development of testable psychotherapeutic competencies in the learners, i.e., their knowledge, skills and values/attitudes, through supervision; on the other hand, supervisors need to develop competence to deliver supervision. Milne and Watkins [ 6 ] describe clinical supervision as “the formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s” (p. 4). In contrast, Bernard and Goodyear [ 7 ] emphasize supervision’s hierarchical approach, in as much as it is provided by more senior to more junior members of a profession. The goals of supervision may thus range between the poles of being normative (i.e., ensuring quality and case management), restorative (i.e., providing emotional and coping support) and formative (i.e., promoting therapeutic competence), and, thus, may ultimately lead to effective and safe psychotherapy [ 6 ]. Hence, it is pivotal for supervisors to reflect upon their own knowledge or skills gaps, and to engage in further qualification [ 8 ]. Clinical supervision may involve different therapeutic approaches and thus addresses therapists from varying mental health backgrounds [ 8 ], which is the stance taken in the current review.

Besides providing a definition of clinical supervision, it is relevant to delineate related terms. One is feedback , a supervision technique that “refers to the ‘timely and specific’ process of explicitly communicating information about performance” ([ 8 ], p. 28). Contrary to supervision, coaching strives to enhance well-being and performance in personal and work domains [ 9 ], and is therefore clearly distinct from supervision and psychotherapy with mental health patients provided by licensed therapists.

In the supervision literature, there is no paucity of narrative reviews, commentaries or concept papers. Previous reviews have revealed positive effects of supervision, for example on supervisee’s satisfaction, autonomy, awareness or self-efficacy [ 10 , 11 , 12 , 13 ]. Still, results on the impact of supervision on patient outcomes are still considered mixed [ 10 ]. Importantly, there is a knowledge gap regarding the active components of supervision, i.e., the effects of supervision or supervisor interventions on supervisees and their patients [ 10 ].

Past reviews, however, suffer from several limitations (for details, see [ 14 ]). First of all, strategies used for literature search and screening have not always been described or implemented rigorously, that is, implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA [ 15 ]) reporting guidelines (e.g. [ 10 , 11 , 12 , 16 , 17 , 18 , 19 ]). Further, several reviews focus specifically on the positive effects of supervision [ 19 ] or specifically on learning disabilities [ 11 ], emphasize the authors’ point of view [ 20 , 21 ], or concentrate on the supervisory relationship only [ 14 ]. While the majority of the above-mentioned reviews are narrative, Alfonsson and colleagues conducted a systematic review [ 14 ], pre-registered and published a review protocol [ 22 ] and implemented a thorough literature search and methodological appraisal. However, since they focused exclusively on cognitive behavioral supervision and on experimental designs, only five studies fit their inclusion criteria. Additionally, interrater agreement was only moderate during screening. Likewise, in our previous scoping review [ 23 ], we concentrated on cognitive behavioral supervision. Furthermore, like other supervision reviews [ 20 , 21 ], it was published in German only, limiting its scope.

Thus, the current systematic review aimed to complement previous reviews by using a comprehensive methodology and concise reporting. First, we aimed to review the current status of supervision interventions (e.g., setting, session frequency, therapeutic background) and of the methodological quality of the empirical literature on clinical supervision. Second, we aimed to provide suggestions for future supervision research.

Materials and methods

We conducted a systematic review by referring to the PRISMA reporting guidelines [ 15 ]. The review protocol was registered and published with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42017072606).

Inclusion and exclusion criteria

We included studies referring to clinical supervision as defined above by Milne and Watkins [ 6 ] above. Both, supervision conducted on its own or as part of a larger intervention (as in psychotherapy training) were included. Treatment studies in which supervision was conducted solely to foster treatment delivery were excluded because they mainly address study adherence and are still covered in other reviews [ 24 , 25 ]. Furthermore, clinical supervision had to refer to psychotherapy, whereas supportive interventions accompanying other treatments (e.g., clinical management) were excluded. Thus, we included studies referring to mental health patients, and studies with patients with physical diseases were considered only if the reason for treatment was patients’ mental health. Studies with another population (e.g., simulated patients or pseudo-clients) were excluded. In order to focus the review in the heterogeneous field of clinical supervision, we limited it to adult patients. Studies on family therapy were included if they focused on adults. Studies with mixed adult and child/adolescent populations were included if the results were reported for the adult population separately. No prerequisites were predefined for supervisor qualification. Any empirical study published within a peer-reviewed process (i.e., without commentaries or reviews) and any outcome measures were included. As such, any supervision outcome (e.g., supervisees’ satisfaction or competence), including negative or unexpected outcomes (e.g., non-disclosure), were allowed. In line with Hill & Knox [ 10 ], we did not focus on studies exclusively examining the supervision process because firstly, it does not provide knowledge on the effectiveness of supervision, and secondly, relationship variables are already covered by other reviews [ 11 ]. Thus, the review focused on supervision interventions, and studies exclusively focusing on the effects of relationship variables or attitudes between the supervisee and supervisor (i.e., as independent variables) were excluded. However, relationship variables were considered if they were considered as dependent variables in the primary studies.

Study search

The bibliographic database search was conducted during February and March 2017 in key electronic mental health databases (Fig.  1 ). To include the current evidence, we focused our search on studies published from 1996 onwards. There were no language restrictions. The following search strategy was used: supervis* AND (psychotherap* OR cognitive-behav* OR behav* therapy OR CBT OR psychodynamic OR psychoanaly* OR occupational therapy OR family therapy OR marital therapy) NOT (management OR employ* OR child* OR adolesc*). Then, we inspected the reference lists of the included studies (backward search) and conducted a cited reference search (forward search). We finished our search in July 2017.

Flowchart on study selection. Adapted from Moher and colleagues (15); SV: supervision

Screening and extraction

Referring to Perepletchikova, Treat and Kazdin [ 26 ], one reviewer (FK) introduced two Master’s psychology students (JM, SW) to the review methods, and the group discussed the review process in weekly one-hour sessions. First, titles and abstracts were screened for inclusion (JM, SW). The first 10% ( n  = 671) of all titles and abstracts were screened by both raters independently. Inter-rater agreement regarding title/abstract screening amounted to κ = .83 [CI = .73–.93], which is considered high [ 27 ].

Next, full texts of eligible and unclear studies were retrieved and then screened again independently by both raters (JM, SW). Disagreements were resolved through discussion or through the inclusion of a third reviewer (FK). If publications were not available through inter-library loans, a copy was requested from the corresponding author. For nine authors, contact details were not retrievable, and out of the 15 authors that were contacted, five replied. Inter-rater agreement concerning full text screenings for inclusion/exclusion was κ = .87 [CI = .77–.97].

For data extraction, we used a structured form that was piloted by three reviewers (FK, JM, SW) on five studies. It comprised information on supervision characteristics (e.g., setting, implementation and competence) and study characteristics (e.g., design, main outcome). Data were extracted independently by two raters, the results were then compared, and disagreements resolved again by mutual inspection of the original data.

Methodological quality

Since we included various study designs, we could not refer to one common tool for the assessment of methodological quality. We therefore developed a comprehensive tool applicable to various study designs to allow for comparability between studies. For the development, we followed prominent recommendations [ 27 , 28 , 29 ]. The items were as follows: a) an appropriate design regarding the study question; b) the selection of participants; c) measurement of variables/data collection; d) control/consideration of confounding variables; and e) other sources of bias (such as allegiance bias or conflicts of interest). Every item was rated on whether low (1), medium (2) or high (3) threats to the methodological quality were supposed. The resulting sum score ranges from 5 to 15, with higher values indicating the possibility of greater threats to the methodological quality. The methodological quality was rated by two review authors independently (JM or SW and FK). Inter-rater reliability for the sum scores reached ICC (1, 2) = .88 [CI = .70–.95], which is considered high [ 30 ]. Disagreements in ratings were again resolved through discussion within the review group.

Due to the heterogeneity of the study designs and outcomes, we will present the review results narratively and in clearly arranged evidence tables.

Current status of supervision

Psychotherapies.

Overall, 15 empirical studies allocated to 19 publications were included (Fig.  1 ). Information on the supervision characteristics is reported on the study level (Table  1 ). Most of the supervisees used cognitive-behavioral therapy (CBT) as the active intervention [ 35 , 37 , 39 , 40 , 43 , 44 , 45 ], in four studies, specific interventions such as Motivational Interviewing (MI [ 38 , 42 ]), Dialectical Behavioral Therapy (DBT [ 41 ];) or Problem Solving Treatment (PST [ 32 ]) were used, and one study referred to psychodynamic therapy [ 31 ] (recommendation to “Conduct supervision from a meta-theoretical perspective”).

Supervisions

Only a minority of studies described any form of supervision manual used or any prior training of supervisors [ 32 , 37 , 38 , 39 , 42 , 43 ]. In most cases, supervisees were postgraduates or had a PhD degree. Regarding the frequency of supervision sessions, most studies reported weekly sessions [ 31 , 32 , 34 , 35 , 37 , 41 , 42 ], and the total number varied considerably from 3 [ 35 ] to 78 sessions [ 31 ]. Three studies did not describe the supervision frequency [ 33 , 36 , 45 ], and one singled out one supervision session only [ 44 ] (recommendation to “Describe how the study is conducted”).

Interventions

Whereas different forms of feedback or multiple-component supervision interventions were commonly studied, active interventions such as role play were seldom used [ 37 , 39 , 40 ]. Three studies did not describe the interventions used within supervision [ 35 , 44 , 45 ] (recommendation to “Investigate active supervision methods”). Four supervisions used a form of live intervention [ 36 , 41 , 42 , 43 ], and the remainder conducted supervision face-to-face. All but five studies [ 32 , 33 , 34 , 44 , 45 ] investigated some form of technological support.

The following sections describe the methodologies used in the studies, which is why all 19 publications are now referred to (Table  2 ). Five were randomized controlled trials (RCTs [ 32 , 34 , 38 , 42 , 43 ];), and one was a cluster-RCT [ 34 ]. In addition to cohort designs [ 31 , 44 ], cross-sectional designs were common [ 35 , 36 , 37 , 45 , 48 , 49 ]. Only in three publications was follow-up data collected [ 33 , 38 , 42 ]. Most studies covering satisfaction with supervision included one assessment time, usually post-intervention [ 34 , 35 , 37 , 39 , 48 , 49 ].

The assessments of the methodological quality are presented in Table  2 . The total methodological quality score was between 9 and 11 in six publications [ 32 , 38 , 41 , 42 , 43 , 46 , 49 ], between 12 and 13 in eight publications (score of 12–12 [ 31 , 33 , 34 , 35 , 36 , 45 , 49 ];), and between 14 and 15 in five of the 19 publications [ 37 , 39 , 40 , 44 , 47 ], with a lower score indicating a lower risk of a threat to the methodological quality. On an item level, most problems referred to the selection of participants, the control of confounders, and other bias such as allegiance bias (Fig.  2 ; recommendation to “Conduct methodologically stringent empirical studies”).

Methodological quality of the included studies. Lower risk … lower possible threats to methodological quality , sum score of 9–11 (range 5–15); medium risk … 12–13; higher risk … 14–15; e.g., 16 studies with higher risk of threats regarding selection of participant issues

Effects of clinical supervision

The most consistent result refers to the high acceptance, satisfaction and the perceived helpfulness of supervision by supervisees [ 34 , 35 , 36 , 37 , 39 , 41 , 44 , 48 , 49 ]. Further, the therapeutic relationship [ 31 , 32 , 43 , 44 , 45 ], and therapeutic competence seem to benefit from supervision [ 37 , 38 , 40 , 42 , 43 ]. On the other hand, non-significant findings [ 34 , 38 ], small effects [ 31 , 44 , 45 ] and relevant alternative explanations [ 32 , 33 , 43 , 46 ] hamper proper conclusions (see Fig.  3 ).

Supervision outcomes and methodological quality of the respective studies. In relation to the methodological quality; e.g., 2 studies with medium and 1 study with higher risk of possible threats to methodological quality investigated the supervisory relationship

Whereas most publications did not describe negative or unexpected effects of supervision, two mentioned them without further specification [ 31 , 42 ], two referred to unwanted effects as being unrelated to the outcome [ 33 , 38 ], and three described limits to therapists’ cognitive capacity and perceived anxiety or stress during supervision [ 39 , 48 , 49 ] (recommendation to “Investigate diverse positive and negative supervision outcomes aside from acceptance”).

The aim of the present study was to systematically review the status and quality of the current empirical literature on clinical supervision and, based on the review findings, to draw conclusions for future studies. The current review identified 19 publications referring to 15 empirical studies on the status of clinical supervision. Despite using wide inclusion criteria, it is remarkable that only such a small number of studies could be included. In contrast to former reviews, our study was conducted systematically according to current guidelines, using a reproducible methodology and concise reporting. Compared to previous reviews, it was not limited to psychotherapeutic approaches or study designs.

Regarding the psychotherapeutic approaches of the supervisees, most interventions had a CBT background, which still documents a research gap in studies on clinical supervision between CBT and other therapeutic approaches.

Aside from psychotherapy approaches, the meta-theoretical perspective of competency-based supervision, as proposed by the American Psychological Association [ 8 ], provides a more integrative and broader view. Their supervision guidelines involve seven key domains central to good-quality supervision, from supervisor competencies to diversity or ethical issues. Importantly, they describe supervision to be science-informed, which again underlines the importance of supervisors and supervisees to keep their evidence-based knowledge and skills up-to-date during profession-long learning.

Considering the conduction of supervision, face-to-face supervision was prevalent, but technological support was common as well, at least in published empirical studies. A variety of interventions was used, including less active ones such as case discussions and coaching, as well as more active ones such as feedback on patient outcomes or supervisee performance. It is clearly positive that active interventions (such as coaching and feedback) were implemented and evaluated because they have proven useful in active learning and therapist training [ 50 ]. Nevertheless, even more active methods, such as exercise or role play, were an exception [ 23 ]. Furthermore, it remains unclear which interventions are helpful in profession-long learning and maintenance of expertise [ 21 , 23 ]. We found that central supervision characteristics, such as the training of supervisors or the manual used for supervision, were not described consistently. Although a detailed description of how studies were conducted seems intuitive, it is surprising that reporting guidelines are not referred to consistently.

Concerning design characteristics, most studies were uncontrolled or used small samples. Further constraints were associated with the lack of follow-up data and major inconsistencies in the evaluation of negative effects. Although external observers, which were only sometimes independent, were used, almost half of the studies relied exclusively on self-reported questionnaires. Another problem was that the heterogeneity in the designs and instruments hampered the quantitative summary of results. Methodological quality has been criticized in supervision research for years (e.g. [ 16 , 17 ],), and inconclusive findings or relevant alternative explanations additionally impeded firm conclusions on supervision effects. Regarding the effects of clinical supervision, the review documents that supervision research clearly lags behind psychotherapy research in general; that is, we still have limited evidence on supervision effects, especially those regarding patient benefits [ 10 ], and we continue to search for active supervision ingredients [ 51 ].

Acceptance and satisfaction are crucial prerequisites for supervision effects, and they were the variables most frequently investigated. Although positive results in these domains may be considered stable [ 13 ], satisfaction may not be confused with effectiveness. Taken from health care-related conceptualizations [ 52 ], subjective satisfaction may depend on a number of variables, such as mutual expectations, communication, the supervisory relationship, the access to supervision or financial strains. In this sense, satisfaction is distinct from learning and competence development. Other important outcomes of supervision, such as the therapeutic relationship and competencies, treatment integrity, patient symptoms or unwanted effects, clearly need further investigation [ 10 , 21 ]. Other ideas include considering not only the supervisory relationship but also supervisory expectations as important process variables across psychotherapeutic approaches [ 13 ].

Limitations

We constructed a short tool for rating methodological quality, which enabled comparisons between the diverse designs of the studies included. Although inter-rater reliability was high, it lacks comparability with other reviews. Due to a stricter operationalization of the inclusion criteria, six studies were included in our previous scoping review [ 23 ], and three were included in another current review [ 14 ] that were not part of the current systematic review. More specifically, one study was not located via our search strategy, and the other publications did not describe explicitly if the patients were adults. As the excluded publications were mainly referring to CBT supervision, it generally reflects the stronger evidence-base of CBT that has its roots in basic research. Since the review aimed to illustrate the status and quality of supervision research, we did not restrict it to specific designs, but mapped the status quo. This necessarily increased heterogeneity, and especially regarding supervision effects, it limited the possibility to draw clear-cut conclusions or to combine the results statistically. Differences in the results of reviews may result not only from methodological aspects but also from diversity in the primary studies, which may be addressed only by better supervision research [ 14 ].

The review provides a variety of starting points for future research. The recommendations derived mainly refer to the replicability of research (i.e., to conduct methodologically stringent empirical studies, and to include positive and negative supervision outcomes). Taking a competency-based view, the following are examples of significant foci of both future practice and supervision research [ 23 , 53 , 54 ]:

Define, review and continuously develop supervisor competencies.

Include active methods, live feedback and video-based supervision.

Enhance the deliberate commitment to ethical standards to protect patients.

Positively value and include scientific knowledge and progress.

Foster profession-long learning of supervisees and supervisors.

Logistics may be an important issue in supervision research. Therefore, if large-scale quantitative studies are difficult to conduct or fund, methodologically sound pragmatic trials [ 3 ] and experimental studies may be feasible alternatives. Most of the results still speak to the lack of scientific rigor in supervision research. Thus, we consider competency-based supervision and research investigating the essential components of supervision as the major goals for future supervision research and practice.

Availability of data and materials

All data generated or analyzed during this study are included in the published article.

Abbreviations

Cognitive-behavioral therapy

Dialectical behavioral therapy

Motivational interviewing

Preferred reporting items for systematic reviews and meta-analyses

International prospective register of systematic reviews

Problem solving treatment

Randomized controlled trial

• Supervision

Falender CA, Shafranske EP. Supervision essentials for the practice of competency-based supervision. Washington, DC: American Psychological Association; 2017.

Book   Google Scholar  

Goodyear RK, Lichtenberg J, Hutman H, Overland E, Bedi R, Christiani K, et al. A global portrait of counselling psychologists’ characteristics, perspectives, and professional behaviors. Couns Psychol Q. 2016;29(2):115–38.

Article   Google Scholar  

Owen J. Supervisory processes in the training of psychotherapists: introduction to the special section. Psychotherapy. 2015;52(2):151–2.

Article   PubMed   Google Scholar  

Falender CA, Shafranske EP. Competence in competency-based supervision practice: construct and application. Prof Psychol Res Pract. 2007;38(3):232–40.

Falender CA, Cornish JAE, Goodyear R, Hatcher R, Kaslow NJ, Leventhal G, et al. Defining competencies in psychology supervision: a consensus statement. J Clin Psychol. 2004;60(7):771–85.

Milne DL, Watkins CE. Defining and understanding clinical supervision: a functional approach. In: Watkins CE, Milne DL, editors. The Wiley international handbook of clinical supervision. Chichester: Wiley; 2014. p. 3–19.

Google Scholar  

Bernard JM, Goodyear RK. Fundamentals of clinical supervision., 3rd ed. Needham Heights: Allyn & Bacon; 2004.

American Psychological Association. Guidelines for clinical supervision in health service psychology. Am Psychol. 2015;70(1):33–46.

International Society for Coaching Psychology. https://www.isfcp.info/what-is-coaching-psychology/ . Accessed 19 June 2019.

Hill CE, Knox S. Training and supervision in psychotherapy. In: Lambert MJ, editor. Bergin and Garfield’s handbook of psychotherapy and behavior change. 6. Hoboken: Wiley; 2013. p. 775–812.

Milne DL, James I. A systematic review of effective cognitive-behavioral supervision. Br J Clin Psychol. 2000;39(2):111–27.

Wheeler S, Richards K. The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Couns Psychother Res. 2007;7(1):54–65.

Watkins CE. How does psychotherapy supervision work? Contributions of connection, conception, allegiance, alignment, and action. J Psychother Integr. 2017;27(2):201.

Alfonsson S, Parling T, Spännargård Å, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cogn Behav Ther. 2017;47(3):1–23.

Moher D, Liberati A, Tetzlaff J, Altman DG. Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Article   PubMed   PubMed Central   Google Scholar  

Ellis MV, Krengel M, Ladany N, Schult D. Clinical supervision research from 1981 to 1993: a methodological critique. J Couns Psychol. 1996;43(1):35–50.

Freitas GJ. The impact of psychotherapy supervision on client outcome: a critical examination of 2 decades of research. Psychotherapy. 2002;39(4):354–67.

Rakovshik SG, McManus F. Establishing evidence-based training in cognitive behavioral therapy: a review of current empirical findings and theoretical guidance. Clin Psychol Rev. 2010;30(5):496–516.

Reiser RP, Milne DL. A systematic review and reformulation of outcome evaluation in clinical supervision: applying the fidelity framework. Train Educ Prof Psychol. 2014;8(3):149–57.

Auckenthaler A. Supervision of psychotherapy: claims, facts, trends. [supervision von Psychotherapie: Behauptungen-Fakten-trends.]. Psychotherapeut. 1999;44(3):139–52.

Strauß B, Wheeler S, Nodop S. Clinical supervision. Review of the state of research. [Klinische supervision: Überblick Über den stand der Forschung.]. Psychotherapeut. 2010;55(6):455–64.

Alfonsson S, Spännargård Å, Parling T, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Syst Rev. 2017;6(1):1–6.

Kühne F, Maas J, Wiesenthal S, Weck F. Supervision in behavioral therapy. A scoping review for identification of research objectives. [Supervision in der Verhaltenstherapie. Ein Scoping Review zur Identifikation von Forschungszielen.]. Zeitschrift für Klinische Psychologie und Psychotherapie. 2017;46(2):73–82.

Muse K, McManus F. A systematic review of methods for assessing competence in cognitive–behavioural therapy. Clin Psychol Rev. 2013;33(3):484–99.

Roth AD, Pilling S, Turner J. Therapist training and supervision in clinical trials: implications for clinical practice. Behav Cogn Psychother. 2010;38(3):291–302.

Perepletchikova F, Treat TA, Kazdin AE. Treatment integrity in psychotherapy research: analysis of the studies and examination of the associated factors. J Consult Clin Psychol. 2007;75(6):829–41.

Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 (updated March 2011). Cochrane Collab; 2011.

CASP Checklist. http://www.casp-uk.net/checklists . Accessed 08 Jan 2018.

Sanderson S, Tatt ID, Higgins J. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666–76.

Wirtz MA, Caspar F. Beurteilerübereinstimmung und Beurteilerreliabilität: Methoden zur Bestimmung und Verbesserung der Zuverlässigkeit von Einschätzungen mittels Kategoriensystemen und Ratingskalen. Göttingen: Hogrefe; 2002.

Anderson T, Crowley MEJ, Patterson CL, Heckman BD. The influence of supervision on manual adherence and therapeutic processes. J Clin Psychol. 2012;68(9):972–88.

Bambling M, King R, Raue P, Schweitzer R, Lambert W. Clinical supervision: its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychother Res. 2006;16(3):317–31.

Davidson KM, Rankin ML, Begley A, Lloyd S, Barry SJE, McSkimming P, et al. Assessing patient progress in psychological therapy through feedback in supervision: the memos randomized controlled trial (measuring and monitoring clinical outcomes in supervision: memos). Behav Cogn Psychother. 2017;45(3):209–24.

Grossl AB, Reese RJ, Norsworthy LA, Hopkins NB. Client feedback data in supervision: effects on supervision and outcome. Train Educ Prof Psychol. 2014;8(3):182–8.

Hiltunen AJ, Kocys E, Perrin-Wallqvist R. Effectiveness of cognitive behavioral therapy: an evaluation of therapies provided by trainees at a university psychotherapy training center. Psych J. 2013;2(2):101–12.

Locke LD, McCollum EE. Clients’ views of live supervision and satisfaction with therapy. J Marital Fam Ther. 2001;27(1):129–33.

Lu W, Yanos PT, Gottlieb JD, Duva SM, Silverstein SM, Xie H, et al. Use of fidelity assessments to train clinicians in the CBT for PTSD program for clients with serious mental illness. Psychiatr Serv. 2012;63(8):785–92.

Martino S, Paris M, Anez L, Nich C, Canning-Ball M, Hunkele K, et al. The effectiveness and cost of clinical supervision for motivational interviewing: a randomized controlled trial. J Subst Abus Treat. 2016;68:11–23.

Milne DL, Reiser RP, Cliffe T, Breese L, Boon A, Raine R, et al. A qualitative comparison of cognitive-behavioural and evidence-based clinical supervision. Cogn Behav Ther. 2011;4(4):152–66.

Ng RMK, Cheung MSM. Supervision of cognitive behavioural therapy for psychosis: a Hong Kong experience. Hong Kong J Psychiatry. 2007;17(4):124–30.

Rizvi SL, Yu J, Geisser S, Finnegan D. The use of “bug-in-the-eye” live supervision for training in dialectical behavior therapy: a case study. Clin Case Stud. 2016;15(3):243–58.

Smith JL, Carpenter KM, Amrhein PC, Brooks AC, Levin D, Schreiber EA, et al. Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing. J Consult Clin Psychol. 2012;80(3):450–64.

Weck F, Jakob M, Neng JMB, Hofling V, Grikscheit F, Bohus M. The effects of bug-in-the-eye supervision on therapeutic alliance and therapist competence in cognitive-behavioural therapy: a randomized controlled trial. Clin Psychol Psychother. 2016;23(5):386–96.

Willutzki U, Tönnies B, Meyer F. Psychotherapy supervision and the therapeutic alliance-A process study. [Psychotherapiesupervision und die therapeutische Beziehung-Eine Prozessstudie.]. Verhaltenstherapie & Psychosoziale Praxis. 2005;37(3):507–16.

Zarbock G, Drews M, Bodansky A, Dahme B. The evaluation of supervision: construction of brief questionnaires for the supervisor and the supervisee. Psychother Res. 2009;19(2):194–204.

Anderson T, Crowley MEJ, Binder JL, Heckman BD, Patterson CL. Does the supervisor's teaching style influence the supervisee's learning prescribed techniques? Psychother Res. 2017;27(5):549–57.

Milne DL, Reiser RP, Cliffe T. An N=1 evaluation of enhanced CBT supervision. Behav Cogn Psychother. 2013;41(2):210–20.

Jakob M, Weck F, Bohus M. Live supervision: From the one-way mirror to video-based online-supervision. [Live-Supervision: Vom Einwegspiegel zur videobasierten Online-Supervision.]. Verhaltenstherapie. 2013;23(3):170–80.

Jakob M, Weck F, Schornick M, Krause T, Bohus M. When the supervisor is watching. Qualitative analysis of the acceptance of live supervision. [Wenn der supervisor zuschaut: qualitative analyse der Akzeptanz von live-supervision.]. Psychotherapeut. 2015;60(3):210–5.

Beidas RS, Kendall PC. Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol Sci Pract. 2010;17(1):1–30.

Rakovshik SG, McManus F, Vazquez-Montes M, Muse K, Ougrin D. Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision. J Consult Clin Psychol. 2016;84(3):191–9.

Brettschneider C, Lühmann D, Raspe H-H. Der Stellenwert von patient-reported outcomes (PRO) im Kontext von health technology assessment (HTA): DIMDI; 2010.

Gonsalvez CJ, Calvert FL. Competency-based models of supervision: principles and applications. Promises Chall Aust Psychologist. 2014;49(4):200–8.

Falender CA. Clinical supervision-the missing ingredient. Am Psychol. 2018;73(9):1240.

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Acknowledgements

We would like to thank the two reviewers for their valuable and important contributions to a former version of the manuscript.

We greatfully acknowledge the support of the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publishing Fund of the University of Potsdam.

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FK conceptualized the research goal, developed the design and the methodology, provided the resources needed for the study, supervised and managed the research, collected the data/evidence, analyzed, synthesized and visualized the study data and wrote the initial draft of the paper. JM and SW aided in collecting the data, in analyzing, synthesizing and visualizing the data and revised the work. FW took part in the conceptualization process, the coordination of the responsibilities, the validation and reviewing process and supervised the research activity. All authors read and approved the final manuscript.

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Kühne, F., Maas, J., Wiesenthal, S. et al. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC Psychol 7 , 54 (2019). https://doi.org/10.1186/s40359-019-0327-7

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The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Affiliations.

• 1 a Department of Clinical Neuroscience, Centre for Psychiatry Research , Karolinska Institutet & Stockholm Health Care Services , Stockholm , Sweden.
• 2 b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.
• 3 c Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
• PMID: 28929863
• DOI: 10.1080/16506073.2017.1369559

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists' competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists' competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists' competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.

Keywords: Clinical supervision; Cognitive Behavior Therapy; empirical research; review; training.

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• Clinical supervision in cognitive behavior therapy improves therapists' competence: a single-case experimental pilot study. Alfonsson S, Lundgren T, Andersson G. Alfonsson S, et al. Cogn Behav Ther. 2020 Sep;49(5):425-438. doi: 10.1080/16506073.2020.1737571. Epub 2020 Mar 26. Cogn Behav Ther. 2020. PMID: 32213046
• The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Alfonsson S, Spännargård Å, Parling T, Andersson G, Lundgren T. Alfonsson S, et al. Syst Rev. 2017 May 11;6(1):94. doi: 10.1186/s13643-017-0486-7. Syst Rev. 2017. PMID: 28490376 Free PMC article.
• Patients' and therapists' experiences of general change mechanisms during bug-in-the-eye and delayed video-based supervised cognitive-behavioral therapy. A randomized controlled trial. Probst T, Jakob M, Kaufmann YM, Müller-Neng JMB, Bohus M, Weck F. Probst T, et al. J Clin Psychol. 2018 Apr;74(4):509-522. doi: 10.1002/jclp.22519. Epub 2017 Oct 24. J Clin Psychol. 2018. PMID: 29064556 Clinical Trial.
• Trainee Therapists' Experiences of Supervision During Training: A Meta-synthesis. Wilson HM, Davies JS, Weatherhead S. Wilson HM, et al. Clin Psychol Psychother. 2016 Jul;23(4):340-51. doi: 10.1002/cpp.1957. Epub 2015 Apr 28. Clin Psychol Psychother. 2016. PMID: 25917244 Review.
• Reflections on supervision in psychotherapy. Fernández-Alvarez H. Fernández-Alvarez H. Psychother Res. 2016;26(1):1-10. doi: 10.1080/10503307.2015.1014009. Epub 2015 Mar 9. Psychother Res. 2016. PMID: 25751649 Review.
• Clinical supervisor's experiences of peer group clinical supervision during COVID-19: a mixed methods study. Doody O, Markey K, Turner J, Donnell CO, Murphy L. Doody O, et al. BMC Nurs. 2024 Sep 2;23(1):612. doi: 10.1186/s12912-024-02283-3. BMC Nurs. 2024. PMID: 39218856 Free PMC article.
• A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. Sohanpal R, et al. Health Technol Assess. 2024 Jan;28(1):1-129. doi: 10.3310/PAWA7221. Health Technol Assess. 2024. PMID: 38229579 Free PMC article. Clinical Trial.
• What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development. Böhm B, Keane G, Karimet M, Palma M. Böhm B, et al. Glob Ment Health (Camb). 2022 Oct 21;9:491-498. doi: 10.1017/gmh.2022.53. eCollection 2022. Glob Ment Health (Camb). 2022. PMID: 36618724 Free PMC article.
• Telesupervision in Psychotherapy: A Bibliometric and Systematic Review. Andreucci-Annunziata P, Mellado A, Vega-Muñoz A. Andreucci-Annunziata P, et al. Int J Environ Res Public Health. 2022 Dec 6;19(23):16366. doi: 10.3390/ijerph192316366. Int J Environ Res Public Health. 2022. PMID: 36498438 Free PMC article. Review.
• Enhancing and assessing fidelity in the TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) trial: development of methods and recommendations for research design. L S, V W, R S, Mj K, H P, Sjc T. L S, et al. BMC Med Res Methodol. 2022 Jun 6;22(1):163. doi: 10.1186/s12874-022-01642-5. BMC Med Res Methodol. 2022. PMID: 35668365 Free PMC article.

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• Open access
• Published: 02 September 2024

Clinical supervisor’s experiences of peer group clinical supervision during COVID-19: a mixed methods study

• Owen Doody   ORCID: orcid.org/0000-0002-3708-1647 1 ,
• Kathleen Markey   ORCID: orcid.org/0000-0002-3024-0828 1 ,
• James Turner   ORCID: orcid.org/0000-0002-8360-1420 2 ,
• Claire O. Donnell   ORCID: orcid.org/0000-0003-2386-7048 1 &
• Louise Murphy   ORCID: orcid.org/0000-0003-2381-3963 1  

BMC Nursing volume  23 , Article number:  612 ( 2024 ) Cite this article

Metrics details

Providing positive and supportive environments for nurses and midwives working in ever-changing and complex healthcare services is paramount. Clinical supervision is one approach that nurtures and supports professional guidance, ethical practice, and personal development, which impacts positively on staff morale and standards of care delivery. In the context of this study, peer group clinical supervision provides allocated time to reflect and discuss care provided and facilitated by clinical supervisors who are at the same grade/level as the supervisees.

To explore the clinical supervisor’s experiences of peer group clinical supervision a mixed methods study design was utilised within Irish health services (midwifery, intellectual disability, general, mental health). The Manchester Clinical Supervision Scale was used to survey clinical supervisors ( n  = 36) and semi-structured interviews ( n  = 10) with clinical supervisors were conducted. Survey data were analysed through SPSS and interview data were analysed utilising content analysis. The qualitative and quantitative data’s reporting rigour was guided by the CROSS and SRQR guidelines.

Participants generally had a positive encounter when providing clinical supervision. They highly appreciated the value of clinical supervision and expressed a considerable degree of contentment with the supervision they provided to supervisees. The advantages of peer group clinical supervision encompass aspects related to self (such as confidence, leadership, personal development, and resilience), service and organisation (including a positive working environment, employee retention, and safety), and patient care (involving critical thinking and evaluation, patient safety, adherence to quality standards, and elevated levels of care).

There are many benefits of peer group clinical supervision at an individual, service, organisation, and patient level. Nevertheless, there is a need to address a lack of awareness and misconceptions surrounding clinical supervision to create an environment and culture conducive to realising its full potential. It is crucial that clinical supervision be accessible to nurses and midwives of all grades across all healthcare services, with national planning to address capacity and sustainability.

Peer Review reports

Within a dynamic healthcare system, nurses and midwives face growing demands, underscoring the necessity for ongoing personal and professional development. This is essential to improve the effectiveness and efficiency of care delivery for patients, families, and societies. Despite the increased emphasis on increasing the quality and safety of healthcare services and delivery, there is evidence highlighting declining standards of nursing and midwifery care [ 1 ]. The recent focus on re-affirming and re-committing to core values guiding nursing and midwifery practice is encouraging such as compassion, care and commitment [ 2 ], competence, communication, and courage [ 3 ]. However, imposing value statements in isolation is unlikely to change behaviours and greater consideration needs to be given to ways in which compassion, care, and commitment are nurtured and ultimately applied in daily practice. Furthermore, concerns have been raised about global staff shortages [ 4 ], the evidence suggesting several contributing factors such as poor workforce planning [ 5 ], job dissatisfaction [ 6 ], and healthcare migration [ 7 ]. Without adequate resources and staffing, compromising standards of care and threats to patient safety will be imminent therefore the importance of developing effective strategies for retaining competent registered nurses and midwives is paramount in today’s climate of increased staff shortages [ 4 ]. Clinical supervision serves as a means to facilitate these advancements and has been linked to heightened job satisfaction, enhanced staff retention, improved staff effectiveness, and effective clinical governance, by aiding in quality improvements, risk management, and heightened accountability [ 8 ].

Clinical supervision is a key component of professional practice and while the aim is largely known, there is no universally accepted definition of clinical supervision [ 8 ]. Clinical supervision is a structured process where clinicians are allowed protected time to reflect on their practice within a supportive environment and with the purpose of developing high-quality clinical care [ 9 ]. Recent literature published on clinical supervision [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] highlights the advantages and merits of clinical supervision. However, there are challenges also identified such as a lack of consensus regarding the meaning and goal, implementation issues, variations in approaches in its operationalisation, and an absence of research evidence on its effectiveness. Duration and experience in clinical supervision link to positive benefits [ 8 ], but there is little evidence of how clinical supervision altered individual behaviours and practices. This is reinforced by Kuhne et al., [ 15 ] who emphasise that satisfaction rather than effectiveness is more commonly examined. It is crucial to emphasise that reviews have pinpointed that clinical supervision lowers the risks of adverse patient outcomes [ 9 ] and demonstrates enhancements in the execution of certain care processes. Peer group clinical supervision is a form of clinical supervision whereby two or more practitioners engage in a supervision or consultation process to improve their professional practice [ 17 ]. There is limited evidence regarding peer group clinical supervision and research on the experiences of peer clinical supervision and stakeholders is needed [ 13 ]. In Ireland, peer group clinical supervision has been recommended and guidelines have been developed [ 18 ]. In the Irish context, peer clinical supervision is where both clinical supervisees and clinical supervisors are peers at the same level/grade. However, greater evidence is required to inform future decisions on the implementation of peer group clinical supervision and the purpose of this study is to explore clinical supervisors’ experiences of peer group clinical supervision. As the focus is on peer group supervisors and utilising mixed methods the experiences of the other stakeholders were investigated and reported separately.

A mixed methods approach was used (survey and semi-structured interviews) to capture clinical supervisor’s experiences of clinical supervision. The study adhered to the Consensus-Based Checklist for Reporting of Survey Studies guidelines [ 19 ] (Supplementary File S1 ) and Standards for Reporting Qualitative Research guidelines [ 20 ] (Supplementary File S2 ).

Participants

This study was conducted with participants who successfully completed a professionally credited award: clinical supervision module run by a university in Ireland (74 clinical supervisors across 5 programmes over 3 years). The specific selection criteria for participants were that they were registered nurses/midwives delivering peer group clinical supervision within the West region of Ireland. The specific exclusion criteria were as follows: (1) nurses and midwives who haven’t finished the clinical supervision module at the University, (2) newly appointed peer group clinical supervisors who have yet to establish their groups and initiate the delivery of peer group clinical supervision.

Measures and procedures

The Manchester Clinical Supervision Scale-26 was used to survey participants in February/March 2022 and measure the peer group clinical supervisors’ overall experiences of facilitating peer group clinical supervision. The Manchester Clinical Supervision Scale-26 is a validated 26-item self-report questionnaire with a Likert-type (1–5) scale ranging from strongly disagree (1) to strongly agree (5) [ 21 ]. The Manchester Clinical Supervision Scale-26 measures the efficiency of and satisfaction with supervision, to investigate the skills acquisition aspect of clinical supervision and its effect on the quality of clinical care [ 21 ]. The instrument consists of two main sections to measure three (normative, restorative, and formative) dimensions of clinical supervision utilising six sub-scales: (1) trust and rapport, (2) supervisor advice/support, (3) improved care/skills, (4) importance/value of clinical supervision, (5) finding time, (6) personal issues/reflections and a total score for the Manchester Clinical Supervision Scale-26 is also calculated. Section two consisted of the demographic section of the questionnaire and was tailored to include eight demographic questions concerning the supervisor’s demographics, supervisee characteristics, and characteristics of clinical supervision sessions. There were also two open field questions on the Manchester Clinical Supervision Scale-26 (model of clinical supervision used and any other comments about experience of peer group clinical supervision). The main question about participants’ experiences with peer clinical supervision was “What was your experience of peer clinical supervision?” This was gathered through individual semi-structured interviews lasting between 20 and 45 min, in March/April 2022 (Supplementary file 3 ).

Ethical considerations

Health service institutional review boards of two University hospitals approved this study (Ref: 091/19 and Ref: C.A. 2199). Participants were recruited after receiving a full explanation of the study’s purpose and procedure and all relevant information. Participants were aware of potential risks and benefits and could withdraw from the study, or the survey could be stopped at any time. Informed consent was recorded, and participant identities were protected by using a pseudonym to protect anonymity.

Data analysis method

Survey data was analysed using the data analysis software package Statistical Package for the Social Sciences, version 26 (SPSS Inc., Chicago, Il, USA). Descriptive analysis was undertaken to summarise responses to all items and categorical variables (nominal and ordinal) were analysed using frequencies to detail the number and percentage of responses to each question. Scores on the Manchester Clinical Supervision Scale-26 were reverse scored for 9 items (Q1-Q6, Q8, Q20,21) and total scores for each of the six sub-scales were calculated by adding the scores for each item. Raw scores for the individual sub-scales varied in range from 0 to 20 and these raw scores were then converted to percentages which were used in addition to the raw scores for each sub-scale to describe and summarise the results of the Manchester Clinical Supervision Scale-26. Cronbach’s alpha coefficient was undertaken with the 26 questions included within the Manchester Clinical Supervision Scale-26 and more importantly with each of the dimensions in the Manchester Clinical Supervision Scale-26. The open-ended questions on the Manchester Clinical Supervision Scale-26 and interviews were analysed using content analysis guided by Colorafi and Evans [ 22 ] and categories were generated using their eight steps, (1) creating a coding framework, (2) adding codes and memos, (3) applying the first level of coding, (4) categorising codes and applying the second level of coding, (5) revising and redefining the codes, (6) adding memos, (7) visualising data and (8) representing the data.

Research rigour

To ensure the validity and rigour of this study the researchers utilised the Manchester Clinical Supervision Scale-26 a recognised clinical supervision tool with good reliability and wide usage. Interviews were recorded, transcribed, and verified by four participants, data were collected until no new components appeared, data collection methods and analysis procedures were described, and the authors’ biases were minimised throughout the research process. The Manchester Clinical Supervision Scale-26 instrument internal consistency reliability was assessed which was overall good (α = 0.878) with individual subscale also good e.g., normative domain 0.765, restorative domain 0.864, and formative domain 0.900. Reporting rigour was demonstrated using the Consensus-Based Checklist for Reporting of Survey Studies guidelines [ 19 ] and Standards for Reporting Qualitative Research guidelines [ 20 ].

Quantitative data

Participant and clinical supervision characteristics.

Thirty-six of the fifty-two (69.2%) peer group clinical supervisors working across a particular region of Ireland responded to the Manchester Clinical Supervision Scale-26 survey online via Qualtrics. Table 1 identifies the demographics of the sample who were predominantly female (94.4%) with a mean age of 44.7 years (SD. 7.63).

Peer group clinical supervision session characteristics (Table  2 ) highlight over half of peer group clinical supervisors ( n  = 20, 55.6%) had been delivering peer group clinical supervision for less than one year and were mainly delivered to female supervisees ( n  = 28, 77.8%). Most peer group clinical supervision sessions took place monthly ( n  = 32, 88.9%) for 31–60 min ( n  = 27, 75%).

Manchester Clinical Supervision Scale-26 results

Participants generally viewed peer group clinical supervision as effective (Table  3 ), the total mean Manchester Clinical Supervision Scale-26 score among all peer group clinical supervisors was 76.47 (SD. 12.801) out of 104, Surpassing the clinical supervision threshold score of 73, which was established by the developers of the Manchester Clinical Supervision Scale-26 as the benchmark indicating proficient clinical supervision provision [ 21 ]. Of the three domains; normative, formative, and restorative, the restorative domain scored the highest (mean 28.56, SD. 6.67). The mean scores compare favourably to that of the Manchester Clinical Supervision Scale-26 benchmark data and suggest that the peer group clinical supervisors were satisfied with both the level of support, encouragement, and guidance they provided and the level of trust/rapport they had developed during the peer group clinical supervision sessions. 83.3% ( n  = 30) of peer group clinical supervisors reported being either very satisfied ( n  = 12, 33.3%) or moderately satisfied ( n  = 18, 50%) with the peer group clinical supervision they currently delivered. Within the peer group clinical supervisor’s supervisee related issues ( n  = 17, 47.2%), work environment-related issues ( n  = 16, 44.4%), staff-related issues ( n  = 15, 41.7%) were reported as the most frequent issues, with patient/client related issues being less frequent ( n  = 8, 22.2%). The most identified model used to facilitate peer group clinical supervision was the Proctors model ( n  = 8, 22.22%), which was followed by group ( n  = 2, 5.55%), peer ( n  = 2, 5.55%), and a combination of the seven-eyed model of clinical supervision and Proctors model ( n  = 1, 2.77%) with some not sure what model they used ( n  = 2, 5.553%) and 58.33% ( n  = 21) did not report what model they used.

Survey open-ended question

‘Please enter any additional comments , which are related to your current experience of delivering Peer Group Clinical Supervision.’ There were 22 response comments to this question, which represented 61.1% of the 36 survey respondents, which were analysed using content analysis guided by Colorafi & Evans [ 22 ]. Three categories were generated. These included: personal value/benefit of peer group clinical supervision, challenges with facilitating peer group clinical supervision, and new to peer group clinical supervision.

The first category ‘personal value/benefit of peer group clinical supervision’ highlighted positive experiences of both receiving and providing peer group clinical supervision. Peer group clinical supervisors reported that they enjoyed the sessions and found them both worthwhile and beneficial for both the group and them as peer group clinical supervisors in terms of creating a trusted supportive group environment and motivation to develop. Peer group clinical supervision was highlighted as very important for the peer group clinical supervisors working lives and they hoped that there would be more uptake from all staff. One peer group clinical supervisor expressed that external clinical supervision was a ‘lifeline’ to shaping their supervisory journey to date.

The second category ‘challenges with facilitating peer group clinical supervision’, identified time constraints, lack of buy-in/support from management, staff shortages, lack of commitment by supervisees, and COVID-19 pandemic restrictions and related sick leave, as potential barriers to facilitating peer group clinical supervision. COVID-19 was perceived to have a negative impact on peer group clinical supervision sessions due to staff shortages, which resulted in difficulties for supervisees attending the sessions during work time. Peer group clinical supervisors felt that peer group clinical supervision was not supported by management and there was limited ‘buy-in’ at times. There was also a feeling expressed that peer group clinical supervision was in its infancy, as COVID-19 and its related restrictions impacted on this by either slowing down the process of commencing peer group clinical supervision in certain areas or having to move online. However, more recently improvements in managerial support and supervisee engagement with the peer group clinical supervision process are noted.

The final category ‘new to peer group clinical supervision’ highlighted that some peer group clinical supervisors were new to the process of providing peer group clinical supervision and some felt that this survey was not a true reflection of their experience of delivering peer group clinical supervision, as they were not fully established yet as clinical supervisors due to the impact of COVID-19. Peer group clinical supervisors identified that while they were new to providing peer group clinical supervision, they were enjoying it and that it was a learning curve for them.

Qualitative data

The qualitative phase explored peer group clinical supervisors’ ( n  = 10) own experiences of preparation received and experiences of being a peer group clinical supervisor. Three themes were identified through data analysis, building the foundations, enacting engagement and actions, and realities (Table  4 ).

Building the foundations

This theme highlights the importance of prior knowledge, awareness, and training but also the recruitment process and education in preparing peer group clinical supervisors.

Knowledge and awareness

Participant’s prior knowledge and awareness of peer group clinical supervision was mixed with some reporting having little or no knowledge of clinical supervision.

I’m 20 years plus trained as a nurse , and I had no awareness of clinical supervision beforehand , I really hadn’t got a clue what all of this was about , so it was a very new concept to me (Bernie) .

Others were excited about peer group clinical supervision and while they could see the need they were aware that there may be limited awareness of the value and process of clinical supervision among peers.

I find that there’s great enthusiasm and passion for clinical supervision as it’s a great support mechanism for staff in practice , however , there’s a lack of awareness of clinical supervision (Jane) .

Recruitment

Some participants highlighted that the recruitment process to become a peer group clinical supervisor was vague in some organisations with an unclear and non-transparent process evident where people were chosen by the organisation’s management rather than self-selecting interested parties.

It was just the way the training was put to the people , they were kind of nominated and told they were going and there was a lot of upset over that , so they ended up in some not going at all (Ailbhe) .

In addition, the recruitment process was seen as top loaded where senior grades of staff were chosen, and this limited staff nurse grade opportunities where there was a clear need for peer group clinical supervisors and support.

We haven’t got down to the ground level like you know we’ve done the directors , we’ve done the CNM3s the CNM2s we are at the CNM1s , so we need to get down to the staff nurse level so the nurses at the direct frontline are left out and aren’t receiving supervision because we don’t have them trained (Bernie) .

Training and education

Participants valued the training and education provided but there was a clear sense of ‘imposter syndrome’ for some peer group clinical supervisors starting out. Participants questioned their qualifications, training duration, and confidence to undertake the role of peer group clinical supervisor.

Because it is group supervision and I know that you know they say that we are qualified to do supervision and you know we’re now qualified clinical supervisors but I’m not sure that a three-month module qualifies you to be at the top of your game (Maria) .

Participants when engaged in the peer group clinical supervisor educational programme did find it beneficial and the true benefit was the actual re-engagement in education and published evidence along with the mix of nursing and midwifery practice areas.

I found it very beneficial , I mean I hadn’t been engaged in education here in a while , so it was great to be back in that field and you know with the literature that’s big (Claire) .

Enacting engagement and actions

This theme highlights the importance of forming the groups, getting a clear message out, setting the scene, and grounding the group.

Forming the groups

Recruitment for the group was of key importance to the peer group clinical supervisor and they all sent out a general invitation to form their group. Some supervisors used invitation letters or posters in addition to a general email and this was effective in recruiting supervisees.

You’re reaching out to people , I linked in with the ADoN and I put together a poster and circulated that I wasn’t ‘cherry picking , and I set up a meeting through Webex so people could get a sense of what it was if they were on the fence about it or unsure if it was for them (Karen) .

In forming the peer clinical supervision groups consideration needs to be given to the actual number of supervisees and participants reported four to six supervisees as ideal but that number can alter due to attendance.

The ideal is having five or six consistent people and that they all come on board and that you get the dynamics of the group and everything working (Claire) .

Getting a clear message out

Within the recruitment process, it was evident that there was a limited and often misguided understanding or perception of peer group clinical supervision.

Greater awareness of what actually clinical supervision is , people misjudge it as a supervision where someone is appraising you , when in fact it is more of a support mechanism , I think peer support is the key element that needs to be brought out (Jane) .

Given the lack of clarity and understanding regarding peer group clinical supervision, the participants felt strongly that further clarity is needed and that the focus needs to be on the support it offers to self, practice, and the profession.

Clinical supervision to me is clinical leadership (Jane) .

Setting the scene and grounding the group

In the initial phase of the group coming together the aspect of setting the scene and grounding the group was seen as important. A key aspect of this process was establishing the ground rules which not only set the boundaries and gave structure but also ensured the adoption of principles of trust, confidentiality, and safety.

We start with the ground rules , they give us structure it’s our contract setting out the commitment the expectation for us all , and the confidentiality as that’s so important to the trust and safety and building the relationships (Brid) .

Awareness of group dynamics is important in this process along with awareness of the group members (supervisees) as to their role and expectations.

I reiterate the role of each person in relation to confidentiality and the relationship that they would have with each other within the group and the group is very much aware that it is based on respect for each person’s point of view people may have a fear of contributing to the group and setting the ground rules is important (Jane) .

To ground the group, peer group clinical supervisors saw the importance of being present and allowing oneself to be in the room. This was evident in the time allocated at the start of each session to allow ‘grounding’ to occur in the form of techniques such as a short meditation, relaxation, or deep breathing.

At the start , I do a bit of relaxation and deep breathing , and I saw that with our own external supervisor how she settled us into place so very much about connecting with your body and you’ve arrived , then always come in with the contract in my first sentence , remember today you know we’re in a confidential space , of course , you can take away information , but the only information you will take from today is your own information and then the respect aspect (Mary Rose) .

This settling in and grounding was seen as necessary for people to feel comfortable and engage in the peer group clinical supervision process where they could focus, be open, converse, and be aware of their role and the role of peer group clinical supervision.

People have to be open, open about their practice and be willing to learn and this can only occur by sharing, clinical supervision gives us the space to do it in a space where we know we will be respected, and we can trust (Claire) .

This theme highlights the importance of the peer group clinical supervisors’ past experiences, delivering peer group clinical supervision sessions, responding to COVID-19, personal and professional development, and future opportunities.

Past experiences

Past experiences of peer group clinical supervisors were not always positive and for one participant this related to the lack of ground rules or focus of the sessions and the fact it was facilitated by a non-nurse.

In the past , I suppose I would have found it very frustrating as a participant because I just found that it was going round in circles , people moaning and you know it wasn’t very solution focused so I came from my situation where I was very frustrated with clinical supervision , it was facilitated by somebody that was non-nursing then it wasn’t very , there wasn’t the ground rules , it was very loose (Caroline) .

However, many did not have prior experience of peer group clinical supervision. Nonetheless, through the education and preparation received, there was a sense of commitment to embrace the concept, practice, and philosophy.

I did not really have any exposure or really much information on clinical supervision , but it has opened my eyes , and as one might say I am now a believer (Brid) .

Delivering peer group clinical supervision

In delivering peer group clinical supervision, participants felt supervisees were wary, as they did not know what peer group clinical supervision was, and they had focused more on the word supervision which was misleading to them. Nonetheless, the process was challenging, and buy-in was questioned at an individual and managerial level.

Buy-in wasn’t great I think now of course people will blame the pandemic , but this all happened before the pandemic , there didn’t seem to be you know , the same support from management that I would have expected so I kind of understood it in a way because then there wasn’t the same real respect from the practitioners either (Mary Rose) .

From the peer group clinical supervisor’s perspective, they were all novices in delivering/facilitating peer group clinical supervision sessions, and the support of the external clinical supervisors, and their own peer group clinical supervision sessions were invaluable along with a clinical supervision model.

Having supervision myself was key and something that is vital and needed , we all need to look at our practice and how we work it’s no good just facilitating others without being part of the process yourself but for me I would say the three principles of clinical supervision , you know the normative , formative and restorative , I keep hammering that home and bring that in regularly and revisit the contract and I have to do that often you know (Claire) .

All peer group clinical supervisors commented on the preparation for their peer group clinical supervision sessions and the importance of them having the right frame of mind and that often they needed to read over their course work and published evidence.

I want everybody to have a shared voice and you know that if one person , there is something that somebody feels very strongly and wants to talk about it that they e-mail in advance like we don’t have a set agenda but that’s agreed from the participant at the start (Caroline) .

To assist this, the peer group clinical supervisors noted the importance of their own peer group clinical supervision, the support of their peers, and external clinical supervisors. This preparation in an unpredictable situation can be difficult but drawing on one’s experience and the experience within the group can assist in navigating beyond unexpected situations.

I utilise the models of clinical supervision and this helps guide me , I am more of a facilitator of the group we are experts in our own area and our own role but you can only be an expert if you take the time to examine your practice and how you operate in your role (Brid) .

All clinical supervisors noted that the early sessions can be superficial, and the focus can be on other practice or management issues, but as time moves on and people become more engaged and involved it becomes easier as their understanding of supervision becomes clearer. In addition, there may be hesitancy and people may have difficulty opening up with certain people in the group and this is a reality that can put people off.

Initially there was so much managerial bashing and I think through supervision , I began to kind of think , I need the pillars of supervision , the governance , bringing more knowledge and it shifted everything in the room , trying to marry it with all the tensions that people have (Mary Rose) .

For some clinical supervisors, there were expected and unexpected challenges for them as clinical supervisors in terms of the discussions veering off course and expectations of their own ability.

The other big challenge is when they go off , how do you bring him back , you know when they veer off and you’re expected to be a peer , but you have to try and recoil that you have to get the balance with that right (Mary Rose) .

While peer group clinical supervision is accepted and seen as a valuable process by the peer group clinical supervisors, facilitating peer group supervision with people known to you can be difficult and may affect the process.

I’d love to supervise a group where I actually don’t know the people , I don’t know the dynamics within the group , and I’d love to see what it would be like in a group (Bernie) .

Of concern to clinical supervisors was the aspect of non-attendance and while there may be valid reasons such as COVID-19 the absence of a supervisee for several sessions can affect the group dynamics, especially if the supervisee has only engaged with early group sessions.

One of the ones that couldn’t attend because of COVID and whatever , but she’s coming to the next one and I just feel there’s a lot of issues in her area and I suppose I’m mindful that I don’t want that sort of thing to seep in , so I suppose it’s just for me just to keep reiterating the ground rules and the boundaries , that’s something I just have to manage as a facilitator , but what if they don’t attend how far will the group have progressed before she attends (Caroline) .

Responding to COVID-19

The advent of COVID-19 forced peer group clinical supervisors to find alternative means of providing peer group clinical supervision sessions which saw the move from face-to-face to online sessions. The online transition was seen as seamless for many established groups while others struggled to deliver sessions.

With COVID we did online for us it was fine because we were already formed (Corina) .

While the transition may have been positive many clinical supervisors came across issues because they were using an online format that would not be present in the face-to-face session.

We did have a session where somebody was in the main office and they have a really loud booming voice and they were saying stuff that was not appropriate to say outside of clinical supervision and I was like are you in the office can you lower it down a bit can you put your headphones on (Maria) .

However, two peer group clinical supervisors ceased or hasted the progress of rolling out peer group clinical supervision sessions mainly due to redeployment and staff availability.

With COVID it just had to be canceled here , it’s just the whole thing was canceled so it was very , very difficult for people (Mary Rose) .

It was clear from clinical supervisors that online sessions were appropriate but that they felt they were only appropriate for existing established groups that have had the opportunity to build relationships, develop trust, embed the ground rules, and create the space for open communication and once established a combined approach would be appropriate.

Since we weren’t as established as a group , not everybody knew each other it would be difficult to establish that so we would hold off/reschedule , obviously COVID is a major one but also I suppose if you have an established group now , and again , you could go to a remote one , but I felt like since we weren’t established as a group it would be difficult to develop it in that way (Karen) .

Within practice COVID-19 took priority and other aspects such as peer group clinical supervision moved lower down on the priority list for managers but not for the clinical supervisors even where redeployment occurred.

With COVID all the practical side , if one of the managers is dealing with an outbreak , they won’t be attending clinical supervision , because that has to be prioritised , whereas we’ve prioritised clinical supervision (Maria) .

The valuing of peer group clinical supervision was seen as important by clinical supervisors, and they saw it as particularly needed during COVID-19 as staff were dealing with many personal and professional issues.

During the height of COVID , we had to take a bit of a break for four months as things were so demanding at work for people but then I realised that clinical supervision was needed and started back up and they all wanted to come back (Brid) .

Having peer group clinical supervision during COVID-19 supported staff and enabled the group to form supportive relationships.

COVID has impacted over the last two years in every shape and they needed the supervision and the opportunity to have a safe supportive space and it gelled the group I think as we all were there for each other (Claire) .

While COVID-19 posed many challenges it also afforded clinical supervisors and supervisees the opportunity for change and to consider alternative means of running peer group clinical supervision sessions. This change resulted in online delivery and in reflecting on both forms of delivery (face-to-face and online) clinical supervisors saw the benefit in both. Face-to-face was seen as being needed to form the group and then the group could move online once the group was established with an occasional periodic face-to-face session to maintain motivation commitment and reinforce relationships and support.

Online formats can be effective if the group is already established or the group has gone through the storming and forming phase and the ground rules have been set and trust built , then I don’t see any problem with a blended online version of clinical supervision , and I think it will be effective (Jane) .

Personal and professional development

Growth and development were evident from peer group clinical supervisors’ experiences and this growth and development occurred at a personal, professional, and patient/client level. This development also produced an awakening and valuing of one’s passion for self and their profession.

I suppose clinical supervision is about development I can see a lot of development for me and my supervisees , you know personally and professionally , it’s the support really , clinical supervision can reinvigorate it’s very exciting and a great opportunity for nursing to support each other and in care provision (Claire) .

A key to the peer group clinical supervisor’s development was the aspect of transferable skills and the confidence they gained in fulfilling their role.

All of these skills that you learn are transferable and I am a better manager because of clinical supervision (Maria) .

The confidence and skills gained translated into the clinical supervisor’s own practice as a clinical practitioner and clinical supervisor but they were also realistic in predicting the impact on others.

I have empowered my staff , I empower them to use their voice and I give my supervisees a voice and hope they take that with them (Corina) .

Fundamental to the development process was the impact on care itself and while this cannot always be measured or identified, the clinical supervisors could see that care and support of the individual practitioner (supervisee) translated into better care for the patient/client.

Care is only as good as the person delivering it and what they know , how they function and what energy and passion they have , and clinical supervision gives the person support to begin to understand their practice and how and why they do things in a certain way and when they do that they can begin to question and even change their way of doing something (Brid) .

Future opportunities

Based on the clinical supervisor’s experiences there was a clear need identified regarding valuing and embedded peer group clinical supervision within nursing/midwifery practice.

There has to be an emphasis placed on supervision it needs to be part of the fabric of a service and valued by all in that service , we should be asking why is it not available if it’s not there but there is some work first on promoting it and people knowing what it actually is and address the misconceptions (Claire) .

While such valuing and buy-in are important, it is not to say that all staff need to have peer group clinical supervision so as to allow for personal choice. In addition, to value peer group clinical supervision it needs to be evident across all staffing grades and one could question where the best starting point is.

While we should not mandate that all staff do clinical supervision it should become embedded within practice more and I suppose really to become part of our custom and practice and be across all levels of staff (Brid) .

When peer group clinical supervision is embedded within practice then it should be custom and practice, where it is included in all staff orientations and is nationally driven.

I suppose we need to be driving it forward at the coal face at induction , at orientation and any development for the future will have to be driven by the NMPDUs or nationally (Ailbhe) .

A formalised process needs to address the release of peer group clinical supervisors but also the necessity to consider the number of peer group clinical supervisors at a particular grade.

The issue is release and the timeframe as they have a group but they also have their external supervision so you have to really work out how much time you’re talking about (Maria) .

Vital within the process of peer group clinical supervision is receiving peer group clinical supervision and peer support and this needs to underpin good peer group clinical supervision practice.

Receiving peer group supervision helps me , there are times where I would doubt myself , it’s good to have the other group that I can go to and put it out there to my own group and say , look at this , this is what we did , or this is what came up and this is how (Bernie) .

For future roll out to staff nurse/midwife grade resourcing needs to be considered as peer group clinical supervisors who were managers could see the impact of having several peer group clinical supervisors in their practice area may have on care delivery.

Facilitating groups is an issue and needs to be looked at in terms of the bigger picture because while I might be able to do a second group the question is how I would be supported and released to do so (Maria) .

While there was ambiguity regarding peer group clinical supervision there was an awareness of other disciplines availing of peer group clinical supervision, raising questions about the equality of supports available for all disciplines.

I always heard other disciplines like social workers would always have been very good saying I can’t meet you I have supervision that day and I used to think my God what’s this fabulous hour that these disciplines are getting and as a nursing staff it just wasn’t there and available (Bernie) .

To address this equity issue and the aspect of low numbers of certain grades an interdisciplinary approach within nursing and midwifery could be used or a broader interdisciplinary approach across all healthcare professionals. An interdisciplinary or across-services approach was seen as potentially fruitful.

I think the value of interprofessional or interdisciplinary learning is key it addresses problem-solving from different perspectives that mix within the group is important for cross-fertilisation and embedding the learning and developing the experience for each participant within the group (Jane) .

As we move beyond COVID-19 and into the future there is a need to actively promote peer group clinical supervision and this would clarify what peer group clinical supervision actually is, its uptake and stimulate interest.

I’d say it’s like promoting vaccinations if you could do a roadshow with people , I think that would be very beneficial , and to launch it , like you have a launch an official launch behind it (Mary Rose) .

The advantages of peer group clinical supervision highlighted in this study pertain to self-enhancement (confidence, leadership, personal development, resilience), organisational and service-related aspects (positive work environment, staff retention, safety), and professional patient care (critical thinking and evaluation, patient safety, adherence to quality standards, elevated care standards). These findings align with broader literature that acknowledges various areas, including self-confidence and facilitation [ 23 ], leadership [ 24 ], personal development [ 25 ], resilience [ 26 ], positive/supportive working environment [ 27 ], staff retention [ 28 ], sense of safety [ 29 ], critical thinking and evaluation [ 30 ], patient safety [ 31 ], quality standards [ 32 ] and increased standards of care [ 33 ].

In this study, peer group clinical supervision appeared to contribute to the alleviation of stress and anxiety. Participants recognised the significance of these sessions, where they could openly discuss and reflect on professional situations both emotionally and rationally. Central to these discussions was the creation of a safe, trustworthy, and collegial environment, aligning with evidence in the literature [ 34 ]. Clinical supervision provided a platform to share resources (information, knowledge, and skills) and address issues while offering mutual support [ 35 ]. The emergence of COVID-19 has stressed the significance of peer group clinical supervision and support for the nursing/midwifery workforce [ 36 ], highlighting the need to help nurses/midwifes preserve their well-being and participate in collaborative problem-solving. COVID-19 impacted and disrupted clinical supervision frequency, duration and access [ 37 ]. What was evident during COVID-19 was the stress and need for support for staff and given the restorative or supportive functions of clinical supervision it is a mechanism of support. However, clinical supervisors need support themselves to be able to better meet the supervisee’s needs [ 38 ].

The value of peer group clinical supervision in nurturing a conducive working environment cannot be overstated, as it indorses the understanding and adherence to workplace policies by empowering supervisees to understand the importance and rationale behind these policies [ 39 ]. This becomes vital in a continuously changing healthcare landscape, where guidelines and policies may be subject to change, especially in response to situations such as COVID-19. In an era characterised by international workforce mobility and a shortage of healthcare professionals, a supportive and positive working environment through the provision of peer group clinical supervision can positively influence staff retention [ 40 ], enhance job satisfaction [ 41 ], and mitigate burnout [ 42 ]. A critical aspect of the peer group clinical supervision process concerns providing staff the opportunity to reflect, step back, problem-solve and generate solutions. This, in turn, ensures critical thinking and evaluation within clinical supervision, focusing on understanding the issues and context, and problem-solving to draw constructive lessons for the future [ 30 ]. Research has determined a link between clinical supervision and improvements in the quality and standards of care [ 31 ]. Therefore, peer group clinical supervision plays a critical role in enhancing patient safety by nurturing improved communication among staff, facilitating reflection, promoting greater self-awareness, promoting the exchange of ideas, problem-solving, and facilitating collective learning from shared experiences.

Starting a group arose as a foundational aspect emphasised in this study. The creation of the environment through establishing ground rules, building relationships, fostering trust, displaying respect, and upholding confidentiality was evident. Vital to this process is the recruitment of clinical supervisees and deciding the suitable group size, with a specific emphasis on addressing individuals’ inclination to engage, their knowledge and understanding of peer group clinical supervision, and dissipating any lack of awareness or misconceptions regarding peer group supervision. Furthermore, the educational training of peer group clinical supervisors and the support from external clinical supervisors played a vital role in the rollout and formation of peer group clinical supervision. The evidence stresses the significance of an open and safe environment, wherein supervisees feel secure and trust their supervisor. In such an environment, they can effectively reflect on practice and related issues [ 41 ]. This study emphasises that the effectiveness of peer group supervision is more influenced by the process than the content. Clinical supervisors utilised the process to structure their sessions, fostering energy and interest to support their peers and cultivate new insights. For peer group clinical supervision to be effective, regularity is essential. Meetings should be scheduled in advance, allocate protected time, and take place in a private space [ 35 ]. While it is widely acknowledged that clinical supervisors need to be experts in their professional field to be credible, this study highlights that the crucial aspects of supervision lie in the quality of the relationship with the supervisor. The clinical supervisor should be supportive, caring, open, collaborative, sensitive, flexible, helpful, non-judgmental, and focused on tacit knowledge, experiential learning, and providing real-time feedback.

Critical to the success of peer group clinical supervision is the endorsement and support from management, considering the organisational culture and attitudes towards the practice of clinical supervision as an essential factor [ 43 ]. This support and buy-in are necessary at both the management and individual levels [ 28 ]. The primary obstacles to effective supervision often revolve around a lack of time and heavy workloads [ 44 ]. Clinical supervisors frequently struggle to find time amidst busy environments, impacting the flexibility and quality of the sessions [ 45 ]. Time constraints also limit the opportunity for reflection within clinical supervision sessions, leaving supervisees feeling compelled to resolve issues on their own without adequate support [ 45 ]. Nevertheless, time-related challenges are not unexpected, prompting a crucial question about the value placed on clinical supervision and its integration into the culture and fabric of the organisation or profession to make it a customary practice. Learning from experiences like those during the COVID-19 pandemic has introduced alternative ways of working, and the use of technology (such as Zoom, Microsoft Teams, Skype) may serve as a means to address time, resource, and travel issues associated with clinical supervision.

Despite clinical supervision having a long international history, persistent misconceptions require attention. Some of these include not considering clinical supervision a priority [ 46 ], perceiving it as a luxury [ 41 ], deeming it self-indulgent [ 47 ], or viewing it as mere casual conversation during work hours [ 48 ]. A significant challenge lies in the lack of a shared understanding regarding the role and purpose of clinical supervision, with past perceptions associating it with surveillance and being monitored [ 48 ]. These negative connotations often result in a lack of engagement [ 41 ]. Without encouragement and recognition of the importance of clinical supervision from management or the organisation, it is unlikely to become embedded in the organisational culture, impeding its normalisation [ 39 ].

In this study, some peer group clinical supervisors expressed feelings of being impostors and believed they lacked the knowledge, skills, and training to effectively fulfil their roles. While a deficiency in skills and competence are possible obstacles to providing effective clinical supervision [ 49 ], the peer group clinical supervisors in this study did not report such issues. Instead, their concerns were more about questioning their ability to function in the role of a peer group clinical supervisor, especially after a brief training program. The literature acknowledges a lack of training where clinical supervisors may feel unprepared and ill-equipped for their role [ 41 ]. To address these challenges, clinical supervisors need to be well-versed in professional guidelines and ethical standards, have clear roles, and understand the scope of practice and responsibilities associated with being a clinical supervisor [ 41 ].

The support provided by external clinical supervisors and the peer group clinical supervision sessions played a pivotal role in helping peer group clinical supervisors ease into their roles, gain experiential learning, and enhance their facilitation skills within a supportive structure. Educating clinical supervisors is an investment, but it should not be a one-time occurrence. Ongoing external clinical supervision for clinical supervisors [ 50 ] and continuous professional development [ 51 ] are crucial, as they contribute to the likelihood of clinical supervisors remaining in their roles. However, it is important to interpret the results of this study with caution due to the small sample size in the survey. Generalising the study results should be approached with care, particularly as the study was limited to two regions in Ireland. However, the addition of qualitative data in this mixed-methods study may have helped offset this limitation.

This study highlights the numerous advantages of peer group clinical supervision at individual, service, organisational, and patient/client levels. Success hinges on addressing the initial lack of awareness and misconceptions about peer group clinical supervision by creating the right environment and establishing ground rules. To unlock the full potential of peer group clinical supervision, it is imperative to secure management and organisational support for staff release. More crucially, there is a need for valuing and integrating peer group clinical supervision into nursing and midwifery education and practice. Making peer group clinical supervision accessible to all grades of nurses and midwives across various healthcare services is essential, necessitating strategic planning to tackle capacity and sustainability challenges.

Data availability

Data are available from the corresponding author upon request owing to privacy or ethical restrictions.

Zelenikova R, Gurkova E, Friganovic A, Uchmanowicz I, Jarosova D, Ziakova K, Plevova I, Papastavrou E. Unfinished nursing care in four central European countries. J Nurs Manage. 2020;28(8):1888–900. https://doi.org/10.1111/jonm.12896 .

Article   Google Scholar  

Department of Health, Office of the Chief Nursing Officer. Position paper 1: values for nurses and midwives in Ireland. Dublin: The Stationery Office; 2016.

Google Scholar  

Cummings J, Bennett V. Developing the culture of compassionate care: creating a new vision for nurses, midwives and care-givers. London: Department of Health; 2012.

Both-Nwabuwe JM, Dijkstra MT, Klink A, Beersma B. Maldistribution or scarcity of nurses: the devil is in the detail. J Nurs Manage. 2018;26(2):86–93. https://doi.org/10.1111/jonm.12531 .

Squires A, Jylha V, Jun J, Ensio A, Kinnunen J. A scoping review of nursing workforce planning and forecasting research. J Nurs Manage. 2017;25:587–96. https://doi.org/10.1111/jonm.12510 .

Sasso L, Bagnasco A, Catania G, Zanini M, Aleo G, Watson R. Push and pull factors of nurses’ intention to leave. J Nurs Manage. 2019;27:946–54. https://doi.org/10.1111/jonm.12745 .

Gea-Caballero V, Castro-Sánchez E, Díaz‐Herrera MA, Sarabia‐Cobo C, Juárez‐Vela R, Zabaleta‐Del Olmo E. Motivations, beliefs, and expectations of Spanish nurses planning migration for economic reasons: a cross‐sectional, web‐based survey. J Nurs Scholarsh. 2019;51(2):178–86. https://doi.org/10.1111/jnu.12455 .

Article   PubMed   Google Scholar  

Cutcliffe J, Sloan G, Bashaw M. A systematic review of clinical supervision evaluation studies in nursing. Int J Ment Health Nurs. 2018;27:1344–63. https://doi.org/10.1111/inm.12443 .

Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health C. 2016;28(4):447–55. https://doi.org/10.1093/intqhc/mzw059 .

Turner J, Hill A. Implementing clinical supervision (part 1): a review of the literature. Ment Health Nurs. 2011;31(3):8–12.

Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse. 2013;45(1):22–32. https://doi.org/10.5172/conu.2013.45.1.22 .

Buss N, Gonge H. Empirical studies of clinical supervision in psychiatric nursing: a systematic literature review and methodological critique. Int J Ment Health Nurs. 2009;18(4):250–64. https://doi.org/10.1111/j.1447-0349.2009.00612.x .

Pollock A, Campbell P, Deery R, Fleming M, Rankin J, Sloan G, Cheyne H. A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals. J Adv Nurs. 2017;73(8):1825–37. https://doi.org/10.1111/jan.13253 .

Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience: a systematic review. BMC Health Serv Res. 2017;17(1):1–11. https://doi.org/10.1186/s12913-017-2739-5 .

Kühne F, Maas J, Wiesenthal S, Weck F. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC Psychol. 2019;7(1):1–11. https://doi.org/10.1186/s40359-019-0327-7 .

Snowdon DA, Sargent M, Williams CM, Maloney S, Caspers K, Taylor NF. Effective clinical supervision of allied health professionals: a mixed methods study. BMC Health Serv Res. 2020;20(1):1–11. https://doi.org/10.1186/s12913-019-4873-8 .

Borders LD. Dyadic, triadic, and group models of peer supervision/consultation: what are their components, and is there evidence of their effectiveness? Clin Psychol. 2012;16(2):59–71.

Health Service Executive. Guidance document on peer group clinical supervision. Mayo: Nursing and Midwifery Planning and Development Unit Health Service Executive West Mid West; 2023.

Sharma A, Minh Duc NT, Lam Thang L, Nam T, Ng NH, Abbas SJ, Huy KS, Marušić NT, Paul A, Kwok CL. Karamouzian, M. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87. https://doi.org/10.1007/s11606-021-06737-1 .

Article   PubMed   PubMed Central   Google Scholar  

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;899:1245–51. https://doi.org/10.1097/ACM.0000000000000388 .

Winstanley J, White E. The MCSS-26©: revision of the Manchester Clinical Supervision Scale© using the Rasch Measurement Model. J Nurs Meas. 2011;193(2011):160–78. https://doi.org/10.1891/1061-3749.19.3.160 .

Colorafi KJ, Evans B. Qualitative descriptive methods in health science research. HERD-Health Env Res. 2016;9:16–25. https://doi.org/10.1177/1937586715614171 .

Agnew T, Vaught CC, Getz HG, Fortune J. Peer group clinical supervision program fosters confidence and professionalism. Prof Sch Couns. 2000;4(1):6–12.

Mc Carthy V, Goodwin J, Saab MM, Kilty C, Meehan E, Connaire S, O’Donovan A. Nurses and midwives’ experiences with peer-group clinical supervision intervention: a pilot study. J Nurs Manage. 2021;29:2523–33. https://doi.org/10.1111/jonm.13404 .

Rothwell C, Kehoe A, Farook SF, Illing J. Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review. BMJ Open. 2021;119:e052929. https://doi.org/10.1136/bmjopen-2021-052929 .

Francis A, Bulman C. In what ways might group clinical supervision affect the development of resilience in hospice nurses. Int J Palliat Nurs. 2019;25:387–96. https://doi.org/10.12968/ijpn.2019.25.8.387 .

Chircop Coleiro A, Creaner M, Timulak L. The good, the bad, and the less than ideal in clinical supervision: a qualitative meta-analysis of supervisee experiences. Couns Psychol Quart. 2023;36(2):189–210. https://doi.org/10.1080/09515070.2021.2023098 .

Stacey G, Cook G, Aubeeluck A, Stranks B, Long L, Krepa M, Lucre K. The implementation of resilience based clinical supervision to support transition to practice in newly qualified healthcare professionals. Nurs Educ Today. 2020;94:104564. https://doi.org/10.1016/j.nedt.2020.104564 .

Feerick A, Doyle L, Keogh B. Forensic mental health nurses’ perceptions of clinical supervision: a qualitative descriptive study. Issues Ment Health Nurs. 2021;42:682–9. https://doi.org/10.1080/01612840.2020.1843095 .

Corey G, Haynes RH, Moulton P, Muratori M. Clinical supervision in the helping professions: a practical guide. Alexandria, VA: American Counseling Association; 2021.

Sturman N, Parker M, Jorm C. Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning. Adv Health Sci Educ. 2021;26:297–311. https://doi.org/10.1007/s10459-020-09986-7 .

Alfonsson S, Parling T, Spännargård Å, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cogn Behav Therapy. 2018;47(3):206–28. https://doi.org/10.1080/16506073.2017.1369559 .

Coelho M, Esteves I, Mota M, Pestana-Santos M, Santos MR, Pires R. Clinical supervision of the nurse in the community to promote quality of care provided by the caregiver: scoping review protocol. Millenium J Educ Technol Health. 2022;2:83–9. https://doi.org/10.29352/mill0218.26656 .

Toros K, Falch-Eriksen A. Structured peer group supervision: systematic case reflection for constructing new perspectives and solutions. Int Soc Work. 2022;65:1160–5. https://doi.org/10.1177/0020872820969774 .

Bifarin O, Stonehouse D. Clinical supervision: an important part of every nurse’s practice. Brit J Nurs. 2017;26(6):331–5. https://doi.org/10.12968/bjon.2017.26.6.331 .

Turner J, Simbani N, Doody O, Wagstaff C, McCarthy-Grunwald S. Clinical supervision in difficult times and at all times. Ment Health Nurs. 2022;42(1):10–3.

Martin P, Tian E, Kumar S, Lizarondo L. A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings. J Adv Nurs. 2022;78:3531–9. https://doi.org/10.1111/jan.15360 .

van Dam M, van Hamersvelt H, Schoonhoven L, Hoff RG, Cate OT, Marije P. Hennus. Clinical supervision under pressure: a qualitative study amongst health care professionals working on the ICU during COVID-19. Med Edu Online. 2023;28:1. https://doi.org/10.1080/10872981.2023.2231614 .

Martin P, Lizarondo L, Kumar S, Snowdon D. Impact of clinical supervision on healthcare organisational outcomes: a mixed methods systematic review. PLoS ONE. 2021;1611:e0260156. https://doi.org/10.1371/journal.pone.0260156 .

Article   CAS   Google Scholar  

Hussein R, Salamonson Y, Hu W, Everett B. Clinical supervision and ward orientation predict new graduate nurses’ intention to work in critical care: findings from a prospective observational study. Aust Crit Care. 2019;325:397–402. https://doi.org/10.1016/j.aucc.2018.09.003 .

Love B, Sidebotham M, Fenwick J, Harvey S, Fairbrother G. Unscrambling what’s in your head: a mixed method evaluation of clinical supervision for midwives. Women Birth. 2017;30:271–81. https://doi.org/10.1016/j.wombi.2016.11.002 .

Berry S, Robertson N. Burnout within forensic psychiatric nursing: its relationship with ward environment and effective clinical supervision? J Psychiatr Ment Health Nurs. 2019;26:7–8. https://doi.org/10.1111/jpm.12538 .

Markey K, Murphy L, O’Donnell C, Turner J, Doody O. Clinical supervision: a panacea for missed care. J Nurs Manage. 2020;28:2113–7. https://doi.org/10.1111/jonm.13001 .

Brody AA, Edelman L, Siegel EO, Foster V, Bailey DE Jr., Bryant AL, Bond SM. Evaluation of a peer mentoring program for early career gerontological nursing faculty and its potential for application to other fields in nursing and health sciences. Nurs Outlook. 2016;64(4):332–8. https://doi.org/10.1016/j.outlook.2016.03.004 .

Bulman C, Forde-Johnson C, Griffiths A, Hallworth S, Kerry A, Khan S, Mills K, Sharp P. The development of peer reflective supervision amongst nurse educator colleagues: an action research project. Nurs Educ Today. 2016;45:148–55. https://doi.org/10.1016/j.nedt.2016.07.010 .

Pack M. Unsticking the stuckness’: a qualitative study of the clinical supervisory needs of early-career health social workers. Brit J Soc Work. 2015;45:1821–36. https://doi.org/10.1093/bjsw/bcu069 .

Bayliss J. Clinical supervision for palliative care. London: Quay Books; 2006.

Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurs Educ Pract. 2013;13(3):165–9. https://doi.org/10.1016/j.nepr.2012.08.009 .

MacLaren J, Stenhouse R, Ritchie D. Mental health nurses’ experiences of managing work-related emotions through supervision. J Adv Nurs. 2016;72:2423–34. https://doi.org/10.1111/jan.12995 .

Wilson HM, Davies JS, Weatherhead S. Trainee therapists’ experiences of supervision during training: a meta-synthesis. Clinl Psychol Psychother. 2016;23:340–51. https://doi.org/10.1002/cpp.1957 .

Noelker LS, Ejaz FK, Menne HL, Bagaka’s JG. Factors affecting frontline workers’ satisfaction with supervision. J Aging Health. 2009;21(1):85–101. https://doi.org/10.1177/0898264308328641 .

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Acknowledgements

The research team would like to thank all participants for their collaboration, the HSE steering group members and Carmel Hoey, NMPDU Director, HSE West Mid West, Dr Patrick Glackin, NMPD Area Director, HSE West, Annette Cuddy, Director, Centre of Nurse and Midwifery Education Mayo/Roscommon; Ms Ruth Hoban, Assistant Director of Nursing and Midwifery (Prescribing), HSE West; Ms Annette Connolly, NMPD Officer, NMPDU HSE West Mid West.

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OD: Conceptualization, Methodology, Formal analysis, Investigation, Writing - Original Draft, Writing - Review & Editing, Project administration, Funding acquisition. COD: Methodology, Formal analysis, Investigation, Writing - Original Draft, Writing - Review & Editing, Funding acquisition. KM: Methodology, Formal analysis, Investigation, Writing - Original Draft, Writing - Review & Editing, Funding acquisition. JT: Methodology, Formal analysis, Writing - Original Draft, Writing - Review & Editing. LM: Methodology, Formal analysis, Investigation, Writing - Original Draft, Writing - Review & Editing, Funding acquisition.

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This study was approved by two health service institutional review boards University Hospital Limerick (Ref: 091/19) and Galway University Hospitals (Ref: C.A. 2199). The study was conducted in accordance with the principles of the Declaration of Helsinki and all study details were fully disclosed to participants, who were assured of the voluntary nature of participation and withdrawal. The study questionnaires were coded, and identities were not disclosed to guarantee participants’ anonymity and all participants provided written informed consent before interviews.

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Doody, O., Markey, K., Turner, J. et al. Clinical supervisor’s experiences of peer group clinical supervision during COVID-19: a mixed methods study. BMC Nurs 23 , 612 (2024). https://doi.org/10.1186/s12912-024-02283-3

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Received : 04 January 2024

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Article Contents

Acknowledgements, supplementary data.

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Characteristics of good supervision: a multi-perspective qualitative exploration of the Masters in Public Health dissertation

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Srinivasa Vittal Katikireddi, Jacqueline Reilly, Characteristics of good supervision: a multi-perspective qualitative exploration of the Masters in Public Health dissertation, Journal of Public Health , Volume 39, Issue 3, September 2017, Pages 625–632, https://doi.org/10.1093/pubmed/fdw107

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A dissertation is often a core component of the Masters in Public Health (MPH) qualification. This study aims to explore its purpose, from the perspective of both students and supervisors, and identify practices viewed as constituting good supervision.

A multi-perspective qualitative study drawing on in-depth one-to-one interviews with MPH supervisors ( n = 8) and students ( n = 10), with data thematically analysed.

The MPH dissertation was viewed as providing generic as well as discipline-specific knowledge and skills. It provided an opportunity for in-depth study on a chosen topic but different perspectives were evident as to whether the project should be grounded in public health practice rather than academia. Good supervision practice was thought to require topic knowledge, generic supervision skills (including clear communication of expectations and timely feedback) and adaptation of supervision to meet student needs.

Two ideal types of the MPH dissertation process were identified. Supervisor-led projects focus on achieving a clearly defined output based on a supervisor-identified research question and aspire to harmonize research and teaching practice, but often have a narrower focus. Student-led projects may facilitate greater learning opportunities and better develop skills for public health practice but could be at greater risk of course failure.

The Masters in Public Health (MPH) was historically the first opportunity to gain the core knowledge and expertise demanded of the discipline, 1 with a dissertation commonly required. Despite this, there is a lack of clarity about the purpose of the MPH dissertation and its necessity long questioned. 2

The modern MPH reaches a range of students with varied disciplines and backgrounds—more so than was historically the case in the UK. This echoes the growing diversity within the public health workforce. 3 – 6 The prior disciplines of students, therefore, now span the breadth of the arts, humanities, sciences as well as the world of healthcare. 3 This increased diversity has allowed a genuinely inter-disciplinary and increasingly international approach which is a necessity for future public health practice and research. 7 – 9

Despite the broad use of the MPH dissertation in many universities, there is limited research on the views of students and supervisors. 10 – 13 Research is necessary since the higher education literature highlights the importance of subject and qualification level in influencing supervision and research–teaching linkages, 14 – 16 with the Master's dissertation particularly regarded as an ill-defined ‘chameleon’. 17 The pedagogical literature draws attention to the benefits of making the processes of postgraduate degree supervision explicit for both supervisors and students. 18 Given the growing diversity of students served by the MPH, and the large number of supervisors, there is a risk that a shared understanding may be lacking. We explored the purpose of the MPH dissertation from the perspective of both students and supervisors, and identify practices viewed as constituting good supervision.

To gain an in-depth understanding of the range of views, a multi-perspective qualitative interview study 19 was undertaken with staff and students. This design explicitly allows diversity in participants’ views to be sought (including comparisons between staff and students). The stated purpose of the MPH dissertation at this institution is to provide an opportunity ‘to carry out an original piece of work’ and projects run from January to August annually. It could involve primary research, analysis of secondary data or a (semi-systematic) literature review.

Potential staff participants were chosen on the basis of their University website profiles, supplemented by snowball sampling. A purposive sample aiming for diversity of supervisor experience (senior staff and junior staff), parent discipline (clinical, social sciences and statistics) and methodological expertise (quantitative and qualitative) was sought. Potential participants were initially sent an information leaflet by e-mail and invited to participate, with a maximum of three e-mails in the case of non-response.

Purposive sampling of students sought diversity of disciplinary background (healthcare related, non-healthcare related), country of origin (UK, international student) and dissertation methodology (quantitative and qualitative). Students supervised by J.R. were ineligible for interview.

Informed consent was obtained at the interview and recorded in writing. Topic guides, informed by existing literature and advice from an expert in pedagogical research (see Acknowledgements), were created to help structure interviews, with coverage of core topics included in both staff and student interviews, but further questions tailored for each set of participants (see Supplementary Appendix ). Staff interviews were carried out by S.V.K. (at the time, a public health specialist registrar who had not supervised MPH dissertations) and student interviews by J.R. (an MPH course university teacher who has supervised many students). All data were collected approximately midway through the dissertation period, so students were still accessible for interviews. Interviews were audio recorded and typically lasted 30–45 min.

Following verbatim transcription, interview data were read repeatedly and analysis proceeded in keeping with the principles of grounded theory. 20 , 21 Inductive thematic coding was conducted by S.V.K. and J.R., with initial descriptive codes created and subsequently recoded to characterize emergent themes. The principle of the constant-comparative method was used to help identify explanations for patterns within the data while also paying attention to contradictory data.

The study was approved by the University of Glasgow College of Medicine and Veterinary Medicine research ethics committee.

Of the 10 staff approached, all agreed to be interviewed but a suitable time could not be arranged with 2, resulting in 8 staff participants (and good sample diversity achieved). Seventeen students were invited to participate and 10 interviewed, with the intended diversity achieved. No further descriptive details or disaggregation of quotations beyond ‘Supervisor’ or ‘Student’ are provided, to ensure anonymity.

Below, we present key emergent themes: first, briefly outlining interviewees’ views on reasons for undertaking the MPH; second, more detailed consideration of the MPH dissertation's purpose in particular; third, perspectives on dissertation supervision and finally, identified tensions that impact on the supervision process. In the Discussion, we build on these findings to develop two putative ideal types to describe alternative dissertation supervision approaches.

The purpose of the MPH

Supervisor: And I know that some of the students come because it's part of their career progression. I think some of them are just really interested in it [public health] and it's a chance to be really interested in something for a year. I guess they're all looking to attain a recognisable qualification which marks them out as having a certain level of knowledge and perhaps some skill, some research skill. […] some of them are looking to get that then to get into public health.

Supervisor: Well I think traditionally it's [the MPH has] been a kind of broad-based preparation for the world of Public Health, for people to take up the types of jobs that they do in fact tend to take up once they graduate from here. So, while it's a fairly academic programme a lot of the posts in Public Health do tend to be fairly academic.

The purpose of the dissertation

While respondents acknowledged that most students would not conduct comparable future research, some saw striking similarity between public health practice and research (Table 1 d). Others also saw the insight experienced from carrying out research as a way to foster improved long-term communication between academia and practice. An alternative view highlighted tailoring the dissertation to the practice environment (Table 1 e) but other respondents cautioned that projects originating from public health practice were often ill-suited, tending to be too broad and not adequately rigorous. The risk that students may be expected to carry out too large a project, as a result of unrealistic employer pressure, was expressed but tempered by an appreciation that employers may reasonably expect some benefits if they have funded students.

Another much debated purpose, and less so students, was the potential for dissertation research to result in academic publications. At best, this was seen as helping align research and teaching responsibilities for supervisors while benefiting students by helping improve their skills and CV (Table 1 f). However, potential benefits to science and the supervisor's career were not accepted uncritically with one supervisor commenting: ‘the reality is—I don't need extra low-grade publications’ . While there was an acknowledgement that publication may constitute a ‘win-win’ , some interviewees felt it might be impossible to achieve as students (and supervisors) may not have the requisite time and patience to follow-up on dissertation work (Table 1 g).

Others expressed concerns about encouraging students to publish or seeing it as a goal to be pursued. If a publication was being considered by the supervisor, it was felt this may limit the student's potential for learning as a narrow project predefined by the supervisor is more likely (Table 1 h). In addition, it was felt to be a more amenable model for dissertations using already collected data; hence, of more relevance for some (primarily quantitative) research. Students may, therefore, be less likely to learn and gain experience in primary data collection, a skill perceived as valuable by some.

Good supervision practice

Supervisors and students broadly agreed on a number of key elements for good supervision. First, it was felt necessary for supervisors to have good knowledge about what constitutes a dissertation and therefore be able to guide students through the process (Table 2 b). Furthermore, having expert knowledge of the topic they were supervising and technical expertise on the research methods were viewed as important. While prior topic knowledge was not always considered essential, supervisors indicated that they would endeavour to learn about it so they could guide the student appropriately. Supervisors were expected to have several skills, including being organized (with accurate note-taking commonly recommended), clear communicators and able to provide pastoral support and encouragement if required (e.g. Table 2 c). More specific suggestions about the conduct of supervision sessions included setting ground rules, providing timely and meaningful feedback and being available to students.

Supervision practice was often viewed as requiring a tailored approach which developed over time, based on student ability, with more directive feedback needed for less well-performing students and more high-level feedback required for students aiming for a distinction. It was acknowledged that this meant not treating students equally, but instead hopefully equitably (Table 2 d). There was general agreement amongst supervisors that flexible supervision was important and strict rules on contact hours per student (as occurs in some MPH degrees) seen as unhelpful. However, the system of varied contact time was deemed potentially problematic by some students (Table 2 e).

Supervisors’ reflections led to some advice for new supervisors. Amongst these was the need to remember that the project is the student's dissertation and not the supervisor's. It was also highlighted that supervisors would inevitably get better with experience but the budding supervisor should accept this as part of the process and forgive themselves for early mistakes.

Pressures on the dissertation process

A tension was identified between students developing their own research topic and the need for supervisors to have some knowledge of the dissertation topic. Some supervisors felt it was preferable for students to play an integral part in conceiving the research question (Table 3 b), while others felt this was unrealistic at the MPH level and within the dissertation timescale (Table 3 c). Other priorities, especially research, were often seen as competing with dissertation supervision but some supervisors attempted to align these two priorities—exemplified by aiming for academic papers resulting from dissertations (Table 3 d).

Tensions were identified between the dissertation as a credentialising tool and as a learning process. The former favours a standardized process which is amenable to clear marking guidelines. Within the department, attempts have been made to accommodate diversity in disciplinary approaches by having specific marking guidelines for different methodologies (such as systematic reviews and qualitative research). However, there was some criticism of this on at least two fronts (Table 3 e). First, the validity of such guidelines and their ability to allow comparison of different forms of research was questioned. Second, the focus on the end product as a piece of research was felt to potentially limit opportunities for conducting more practice-orientated work (as carried out within government departments or elsewhere), which might be more relevant to a student's learning requirements but less easily definable as a specific form of research (Table 3 f).

Main finding of this study

Students and supervisors generally agreed that the MPH dissertation serves several purposes, including providing an opportunity to develop skills, apply learning from taught courses and help prepare for future work. Supervision is often tailored to students’ evolving needs and while a number of behaviours facilitate basic competence, good supervision is to some extent learnt from experience. However, we identified tensions in the supervision process, with two ideal types discernible (see Fig. 1 ). Supervisor-led dissertations tend to be narrowly defined by the supervisor and well suited to the credentialising purpose of the dissertation. In contrast, a student-led dissertation is more tailored to public health practice and some students’ learning requirements. The latter may require greater supervisor effort and put the student at greater risk of failure when the end product is assessed against criteria for a research product. In reality, a broad continuum exists between these ideal types and they represent a negotiated process that unfolds over time, rather than equating to supervisors (who may tend to operate more in one mode than another but switch their practice depending on the project and student).

A representation of two ‘ideal types’ of the MPH dissertation process.

What is already known?

Existing pedagogical literature supports some of the themes we identify including what constitutes good supervision practice (such as subject expertise and guidance on time management and writing) and having a student focus. 22 , 23 A recent Dutch qualitative study of pedagogy identified the importance of Master's supervisors adapting to students’ needs, but not their expectations. 24 Similar diversity in Master's in Medical Education projects has been previously found, as have tensions between service commitments for NHS staff and their postgraduate supervision roles, prompting the authors to call for less reliance on service staff. 25

Views on the benefits of a research perspective for students appear mixed. Struthers et al . sought views from medical, veterinary and dental schools, finding that many academic staff felt research thinking and skills were important in informing professional practice. 26 In contrast, Gabbay highlighted a perceived gulf between public health research and practice some time ago, arguing for experiential learning grounded in the real world. 27 Much of the higher education research has focussed on whether research improves teaching quality but a meta-analysis found little relationship between the two. 28 In contrast, qualitative research suggested that a complex interplay exists between research and teaching which varies by each individual academic. 16

Achieving synergies across research and teaching is an academic priority in many institutions, with the publication of students’ research projects noted to be a potentially important way to encourage future researchers. 26 In addition, public health academic departments have long had close relationships with practice—a strength which could be diminished as a result. 29

What this study adds?

By identifying the diverse expectations and needs of students, we hope supervisors are better able to match their supervision style to deliver the best possible learning experience and that our model assists in achieving this. Our study also suggests that a linkage between research and teaching is not without risk since academics may focus on one over the other. 14 A research emphasis may result in public health practice skills being neglected. 3 Our study goes beyond viewing research and teaching as in opposition or synergy. Instead, it points to a potential parallel to the posited ‘squeeze on intellectual spaces’—occurring when researchers have their academic freedom limited by the increasing focus on producing applied knowledge. 30 Our findings raise the possibility that a comparable ‘squeeze on learning spaces’ may be occurring, where students’ freedom to explore and learn during the dissertation is curtailed—echoing a perceived decline in the intellectual environment experienced by postgraduate nursing students. 31 This may result in MPH graduates finding it more difficult to bring together disparate research approaches in the manner often required for practice.

Limitations of this study

This study investigated the topic of MPH dissertation supervision using qualitative interviews with supervisors and students, but several limitations exist. First, this is a small-scale study at a single institution. Further work is needed to establish the extent that these themes are evident elsewhere, including within more practice-oriented MPHs. That said, many respondents had experience of teaching elsewhere and supervisors felt dissertation supervision did not differ markedly between universities but more by supervisor. Second, while the interviewers’ institutional positions assisted in accessing interviewees, data obtained are influenced by our working relationships. For example, students may have been less open to voicing criticisms, particularly since the dissertation was ongoing. Lastly, while we have introduced a continuum of dissertation supervision types, this interpretation should be considered preliminary and further longitudinal studies to explore the evolving nature of supervision over time is needed.

We report several findings worthy of reflection by new and experienced MPH dissertation supervisors alike. An awareness of the different purposes may assist supervisors to tailor their own and their department's supervision. Tensions identified in supervision raise questions about how academic public health departments could best respond to students’ changing needs. We hope such critical reflection of current pedagogical practice will assist in improving training for future generations of public health professionals. 32

The authors would like to thank the study participants and the supervisor of their Postgraduate Certificate in Academic Practice qualification, Dr Catherine Bovill.

Supplementary data are available at the Journal of Public Health online .

This study received no specific funding; S.V.K. was funded by the Chief Scientist's Office of the Scottish Government (SCAF/15/02 and SPHSU15), Medical Research Council (MC_UU_12017/15) and NHS Research Scotland.

Berridge V , Gorsky M , Mold A . Public Health in History—Understanding Public Health . Maidenhead : Open University Press , 2011 .

Cohen J , Robertson AM . A postgraduate public-health course: from the students’ point of view . Lancet 1961 ; 277 : 102 – 5 .

Google Scholar

Griffiths S , Crown J , McEwen J . The role of the Faculty of Public Health (Medicine) in developing a multidisciplinary public health profession in the UK . Public Health 2007 ; 121 : 420 – 5 .

Evans D , Adams L . Through the glass ceiling--and back again: the experiences of two of the first non-medical directors of public health in England . Public Health 2007 ; 121 : 426 – 31 .

Pilkington P . Improving access to and provision of public health education and training in the UK . Public Health 2008 ; 122 : 1047 – 50 .

Jenner D , Hill A , Greenacre J et al.  . Developing the public health intelligence workforce in the UK . Public Health 2010 ; 124 : 248 – 52 .

Katikireddi SV , Higgins M , Smith KE et al.  . Health inequalities: the need to move beyond bad behaviours . JECH 2013 ; 67 : 715 – 6 .

McMichael AJ , Beaglehole R . The changing global context of public health . Lancet 2000 ; 356 : 495 – 9 .

McPherson K , Taylor S , Coyle E . For and against: public health does not need to be led by doctors . BMJ 2001 ; 322 : 1593 – 6 .

El Ansari W , Oskrochi R . What matters most? Predictors of student satisfaction in public health educational courses . Public Health 2006 ; 120 : 462 – 73 .

El Ansari W , Russell J , Spence W et al.  . New skills for a new age: leading the introduction of public health concepts in healthcare curricula . Public Health 2003 ; 117 : 77 – 87 .

El Ansari W , Russell J , Wills J . Education for health: case studies of two multidisciplinary MPH/MSc public health programmes in the UK . Public Health 2003 ; 117 : 366 – 76 .

Le L , Bui Q , Nguyen H et al.  . Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health . Hum Resour Health 2007 ; 5 : 24 .

Fox MF . Research, teaching, and publication productivity: mutuality versus competition in academia . Sociol Educ 1992 ; 65 : 293 – 305 .

Gunn V , Draper S , McKendrick M . Research-Teaching Linkages: Enhancing Graduate Attributes—Arts, Humanities and Social Sciences . Mansfield : The Quality Assurance Agency for Higher Education , 2008 .

Google Preview

Robertson J , Bond CH . Experiences of the relation between teaching and research: what do academics value . High Educ Res Dev 2001 ; 20 : 5 – 19 .

Pilcher N . The UK postgraduate Masters dissertation: an ‘elusive chameleon’ . Teach High Educ 2011 ; 16 : 29 – 40 .

Delamont S , Atkinson P , Parry O . Supervising the PhD. A guide to success . Maidenhead: Open University Press, 1997 .

Kendall M , Murray SA , Carduff E et al.  . Use of multiperspective qualitative interviews to understand patients’ and carers’ beliefs, experiences, and needs . BMJ 2009 : 339 .

Glaser BG , Strauss AL The Discovery of Grounded Theory: Strategies for Qualitative Research . New Jersey : Transaction Books , 2009 .

Mason J. Qualitative Researching , 2nd edn. London : Sage Publications Ltd , 2002 .

McMichael P . Tales of the unexpected: supervisors’ and students’ perspectives on short‐term projects and dissertations . Educ Stud 1992 ; 18 : 299 – 310 .

Harrison R , Gemmell I , Reed K . Student satisfaction with a web-based dissertation course: findings from an international distance learning master's programme in public health . Int Rev Res Open Dist Learn 2014 ; 15 : 182 – 202 .

de Kleijn RAM , Bronkhorst LH , Meijer PC, et al.  . Understanding the up, back, and forward-component in master's thesis supervision with adaptivity . Stud High Educ 2014 : 1 – 17 . http://dx.doi.org/10.1080/03075079.2014.980399 .

Pugsley L , Brigley S , Allery L et al.  . Making a difference: researching master's and doctoral research programmes in medical education . Med Educ 2008 ; 42 : 157 – 63 .

Struthers J , Laidlaw A , Aiton J , et al.  . Research-Teaching Linkages: Enhancing Graduate Attributes—Medicine, Dentistry and Veterinary Medicine . Mansfield : The Quality Assurance Agency for Higher Education , 2008 .

Gabbay J . Courses of action—the case for experiential learning programmes in public health . Public Health 1991 ; 105 : 39 – 50 .

Hattie J , Marsh HW . The relationship between research and teaching: a meta-analysis . Rev Educ Res 1996 ; 66 : 507 – 42 .

Bhopal R . The context and role of the US school of public health: implications for the United Kingdom . J Public Health (Oxf) 1998 ; 20 : 144 – 8 .

Smith K . Research, policy and funding—academic treadmills and the squeeze on intellectual spaces . Br J Sociol 2010 ; 61 : 176 – 95 .

Drennan J , Clarke M . Coursework master's programmes: the student's experience of research and research supervision . Stud High Educ 2009 ; 34 : 483 – 500 .

Larrivee B . Transforming teaching practice: becoming the critically reflective teacher . Reflect Pract 2000 ; 1 : 293 – 307 .

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CJJC students spent the year diligently preparing for trial, organizing and mastering discovery, and conducting investigative tasks. Their contributions were critical and wide-ranging. Students helped draft direct and cross examinations, the opening statement, the closing argument, and pre-trial motions, and they also appeared in court. Prior to trial, CJJC student Jordan Cohen, ’24 , successfully argued against one of the State’s motions in limine. During trial, three CJJC students— Zoe Belford, ’24 , Laura Breckenridge, ’24 , and Caleb Jeffreys, ’24 —conducted direct examinations of key defense witnesses. Caleb shared his thoughts on representing our client at trial here . Maggie Wells, ’24 , and Ajoke Adetula, ’25, were also key members of the trial team and assisted with every aspect of trial preparation.

This trial victory built on the excellent work of previous generations of CJJC students who reviewed discovery, litigated and argued pre-trial motions, retained critical defense experts, conducted investigative work, and completed other important tasks.

Cook County Criminal Cases

The CJJC continued work on several pretrial felony cases at the 26th and California Criminal Courthouse and took on a new case.

In one case, the CJJC negotiated a diversionary disposition under Illinois’s expanded First Time Weapons Offense Program (FTWOP) for a client with no criminal history and a personal background of profound trauma. After nearly a year of our client’s participation in the program, CJJC student Juliana Steward, ’24 , argued that our client’s supervision should be ended early, and the underlying charges dismissed, so that the case would no longer interfere with her employment and career advancement. CJJC students Laura Breckenridge, ‘24 , and Nicholas Smith, ’24 , researched and drafted a persuasive motion to suppress evidence in the 2022-23 school year, which was instrumental in persuading prosecutors to offer participation in the FTWOP.

In another case, the CJJC collaborated with Precious Blood Ministry of Reconciliation (PBMR), a restorative justice non-profit organization based in the Back of the Yards neighborhood, to represent a nineteen-year-old young man who is actively involved with PBMR. Under the supervision of Professor Zunkel, the CJJC student team, consisting of Matt Maxson, ’24 , Sebastian Torero, ’24 , Ajoke Adetula, ’25 , and Jessica Ritchie, ’25 , reviewed and catalogued discovery; researched, drafted, and argued a motion for release under Illinois’s new Pretrial Fairness Act; researched and drafted a motion to suppress evidence; prepared an impactful mitigation video; and assisted with plea negotiations. Our client ultimately pled guilty pursuant to a favorable plea agreement. Under the supervision of Professor Zunkel, Sebastian Torero, ’24 represented our client at his pretrial release hearing and the plea and sentencing hearing.

Excessive Sentences Project

In 2023, Professor Zunkel launched the Excessive Sentences Project (ESP) to ameliorate unjust and excessive sentences and combat mass incarceration in Illinois and the federal system. This project builds on Professor Zunkel’s groundbreaking sentence reduction work in the Federal Criminal Justice Clinic (FCJC). The ESP’s work took multiple forms: (1) litigating federal post-conviction sentence reduction motions, with a specific focus on clients who are serving lengthy mandatory minimum sentences that would be drastically lower today; and (2) broader advocacy for the increased use of second look mechanisms.

The federal sentence reduction statute permits a judge to reduce an individual’s sentence for “extraordinary and compelling” reasons. On November 1, 2023, the Sentencing Commission’s updated policy statement went into effect, which permits sentence reductions for family circumstances, abuse in prison, medical reasons, when an individual’s sentence is “unusually long,” or any other “extraordinary and compelling” reason. Professor Zunkel and her client, Dwayne White, previously testified in favor of expanding the grounds for a sentence reduction. In 2018, Congress reformed the sentence reduction statute so that people in federal prisons can bring sentence reduction motions to judges, rather than waiting for the Bureau of Prisons to grant relief.

The CJJC litigated numerous sentence reduction motions over the course of the year. Building on eleven prior successful motions for sentence reductions, including eight early releases for individuals convicted in connection with the government’s Illinois stash house reverse sting operations, Professor Zunkel and Nathaniel Berry, ’24 , filed another sentence reduction motion for a stash house client, which was granted in February 2024. As a result, our client was released from prison ten years early from his twenty-five-year mandatory minimum sentence. In addition, Professor Zunkel and Juliana Steward, ‘24 , in collaboration with Professor Alison Siegler and a team of FCJC students, filed a sentence reduction motion for a stash house client who is serving a thirty-five-year sentence and is one of just two people still imprisoned for the Illinois stash house operations. Our motion is currently pending. Professor Zunkel’s successful stash house sentence reduction litigation was featured in a recent episode of the Drugs on the Docket podcast.

Professor Zunkel, Nathaniel Berry, ’24 , Nicholas Smith, ’24 , Maggie Wells, ’24 , Christiana Burnett, ’25 , and Julianne Kelleher, ’25 also filed several sentence reduction motions under the Sentencing Commission’s updated policy statement for clients who received life or defacto life sentences that would be drastically lower today based on “once-in-a generation” legal changes that Congress did not make retroactive. Students spent countless hours scouring our clients’ case records, reaching out to our clients and their families and friends to verify release plans, conducting legal research, and drafting the motions. These motions are currently pending.

In addition to representing clients, Professor Zunkel and CJJC students advocated more broadly for expanding post-conviction second looks. Professor Zunkel and CJJC student Nathaniel Berry, ’24 authored an op-ed in USA Today on the importance of the Sentencing Commission’s new “unusually long sentences” ground for a sentence reduction. The piece highlighted CJJC client Dion Walker, who is serving a mandatory life sentence for drug trafficking that he could not receive today. In September 2023, Professor Zunkel, Nathaniel Berry, ’24 , and Maggie Wells, ’24 presented with FAMM General Counsel Mary Price and Professor Alison Guernsey (Director, University of Iowa Law School Federal Criminal Defense Clinic) at the Second Look Network’s conference about the Sentencing Commission’s updated policy statement and second looks in the federal system. Professor Zunkel also spoke at the Midwest Clinical Conference and FAMM’s Second Chances Convening about the Sentencing Commission’s updated policy statement.

In recognition of her sentence reduction work, Professor Zunkel received the Excellence in Pro Bono Service Award from the United States Northern District of Illinois District Court and the Federal Bar Association.

CJJC Students

Sixteen students participated in the CJJC in the 2023-24 academic year. Of the eleven third-year students in the CJJC, seven argued in court behalf of our clients under Professor Conyers’ and/or Professor Zunkel’s supervision pursuant to Illinois Supreme Court Rule 711. Maggie Wells, ’24 won the Mandel Award for outstanding contributions to the clinical program. Over the course of her time in the CJJC, Maggie worked on the CJJC’s juvenile trial case, the Excessive Sentences Project, and one of the CJJC’s pretrial criminal cases. Our CJJC graduating students have bright futures: five students are going on to federal clerkships, two are working in public interest positions, and several are going to law firms.