Basic Model of Supervision

Journal Club Article: Milne, D., Aylott, H., Fitzpatrick, H., & Ellis, M. V. (2008). How does clinical supervision work? Using a “best evidence synthesis” approach to construct a basic model of supervisionThe Clinical Supervisor27(2), 170-190.

Background: One of the major challenges hindering the further development of clinical supervision has been poor conceptualization in both theory and empirical studies.

Aim: To address deficiencies in the clinical supervision literature, aimed to build an inductively derived basic conceptualisation of effective, empirically supported supervision, one with appropriate complexity.

Method: Using a ‘best evidence synthesis’ strategy, which entails conducting a systematic quantitative review of the literature and then applying a qualitative-constructivist methodology to the quantitative and qualitative review data. A best evidence synthesis utilises both quantitative and qualitative research methodologies in the context of a literature review.

Findings: Best evidence synthesis: “The model features 32 contextual variables of successful supervision (e.g., administrative support), 26 supervision interventions (i.e., corrective feedback), and 28 outcomes (i.e., how supervisees learned from supervision). “

Results from Table 1. Supervision Interventions in the 24 Reviewed Studies, Ranked by Frequency of Occurrence.

 No. Studies% Studies PrevalenceRank
Training (teaching skills/instruction)18751
Feedback15632
Observing (live or recorded)10423
Goal-setting9384.5
Question-and-answer (information gathering; clarifying)9384.5
Modeling (demonstration, live or video/audio)7296
Planning (including managing; agenda; next meeting)6257.5
Reinforcement/praise/support6257.5
Discussion (review)52110
Prompts (verbal and written reminders, handout, etc.)52110
Role-play52110
Explanation (rationale provided socialization to model)41712.5
Monitoring (evaluating) client benefit/supervisee performance41712.5
Review/reflection52112.5
Summarizing41714.5
Challenging (rethink)31315
Self-monitoring1418
Listening2818
Problem-solving2818
Rehearsal of skills2818
Self-disclosure31318
Collaborating (working together)1423
Confidence building (efficacy)1423
Disagreeing1423
Formulating (modeling problem)1423
Understanding checked multiple/varied elements counted only once (e.g., different types of training)1423

The 26 supervision interventions, where collapsed into the categories of teaching (75% of studies), providing corrective feedback (63%), observing (42%), and other popular supervision interventions.

Results from Table 2. Supervision Outcomes Reported in 24 Reviewed Studies, Ranked by Frequency of Occurrence

 No. Studies Specifying% StudiesRank
Experiencing (attitude change; affective awareness; motivation/reinforcement)12501
Other (general “learning”; self-monitoring/supervision)5202
Reflection (to raise self-awareness/evaluation, positive and negative)3123
Planning (increased attention to goals/focusing)4164
Conceptualizing28=5.5
Experimenting (“exposure”/learning by doing)28=5.5

Summary

The basic model of supervision “proposes that supervision is a complex activity, one that is contextualized by at least five major types of contextual variables and implemented (mediated) through over two dozen supervision interventions. These interventions are thought to work primarily by promoting experiential learning (i.e., the outcome or mechanism of change).”

Resources

Milne, D., Aylott, H., Fitzpatrick, H., & Ellis, M. V. (2008). How does clinical supervision work? Using a “best evidence synthesis” approach to construct a basic model of supervisionThe Clinical Supervisor27(2), 170-190.

Nursing Education Network. (2016). Restorative Practice.

Nursing Education Network. (2019). Clinical Supervision in Nursing.