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 supervision. The Clinical Supervisor, 27(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 Prevalence | Rank | |
|---|---|---|---|
| Training (teaching skills/instruction) | 18 | 75 | 1 |
| Feedback | 15 | 63 | 2 |
| Observing (live or recorded) | 10 | 42 | 3 |
| Goal-setting | 9 | 38 | 4.5 |
| Question-and-answer (information gathering; clarifying) | 9 | 38 | 4.5 |
| Modeling (demonstration, live or video/audio) | 7 | 29 | 6 |
| Planning (including managing; agenda; next meeting) | 6 | 25 | 7.5 |
| Reinforcement/praise/support | 6 | 25 | 7.5 |
| Discussion (review) | 5 | 21 | 10 |
| Prompts (verbal and written reminders, handout, etc.) | 5 | 21 | 10 |
| Role-play | 5 | 21 | 10 |
| Explanation (rationale provided socialization to model) | 4 | 17 | 12.5 |
| Monitoring (evaluating) client benefit/supervisee performance | 4 | 17 | 12.5 |
| Review/reflection | 5 | 21 | 12.5 |
| Summarizing | 4 | 17 | 14.5 |
| Challenging (rethink) | 3 | 13 | 15 |
| Self-monitoring | 1 | 4 | 18 |
| Listening | 2 | 8 | 18 |
| Problem-solving | 2 | 8 | 18 |
| Rehearsal of skills | 2 | 8 | 18 |
| Self-disclosure | 3 | 13 | 18 |
| Collaborating (working together) | 1 | 4 | 23 |
| Confidence building (efficacy) | 1 | 4 | 23 |
| Disagreeing | 1 | 4 | 23 |
| Formulating (modeling problem) | 1 | 4 | 23 |
| Understanding checked multiple/varied elements counted only once (e.g., different types of training) | 1 | 4 | 23 |
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 | % Studies | Rank | |
|---|---|---|---|
| Experiencing (attitude change; affective awareness; motivation/reinforcement) | 12 | 50 | 1 |
| Other (general “learning”; self-monitoring/supervision) | 5 | 20 | 2 |
| Reflection (to raise self-awareness/evaluation, positive and negative) | 3 | 12 | 3 |
| Planning (increased attention to goals/focusing) | 4 | 16 | 4 |
| Conceptualizing | 2 | 8 | =5.5 |
| Experimenting (“exposure”/learning by doing) | 2 | 8 | =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 supervision. The Clinical Supervisor, 27(2), 170-190.
Nursing Education Network. (2016). Restorative Practice.
Nursing Education Network. (2019). Clinical Supervision in Nursing.