All physiotherapists began their careers with some time spent as a supervisee. Initially, time was spent supervised as a student and then as a physiotherapist intern. Supervision is an integral part of learning and gaining competence through the ongoing assessment and evaluation of a supervisee’s technical and non-technical skills. The College recognizes the importance of supervision in developing skills and professional competencies that allow physiotherapists to meet the expectations found in the Standards of Practice and Code of Ethical Conduct. Hopefully, this article can provide both supervisors and those they supervise with some insights into how to make the most of the supervisory relationship.
“The term clinical supervision is defined as a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence and is acknowledged to be a life-long process…”1
It is important to think of clinical supervision differently than management supervision though both involve formal appraisal of someone’s work. Clinical supervision is less about productivity and time management and more about assessing and reviewing areas that require growth and enabling a physiotherapist to reflect upon their practice and clinical skills. The idea is to provide an environment where a clinician with less experience can be supported and can enhance their practice through regular supervision to promote better patient outcomes.
Clinical supervision should be set up in a way that enables the supervisees to reflect on and review their work. This can be done in many ways, and it is important to take the supervisee’s learning style into account for these types of reviews and reflections. The one key component to this, which applies to almost every clinical supervision process, is that it must be done at regular intervals and there should be continual contact.
5 Benefits of Supervision
There can be many benefits to supervising physiotherapy students or physiotherapist interns. This is what most physiotherapists will attest to as well as what the research continues to show. 2,3
- Improved job satisfaction
Taking on the role of a supervisor can bring a feeling of satisfaction and professional pride to many physiotherapists. Having someone to work with closely in the practice setting who is eager to learn and excited to be involved in the physiotherapy profession can reinvigorate the daily routine and challenge the status quo.
2. Improved staff retention
There is evidence of increased staff retention in environments where supportive supervision is a key component of the workplace. Worksites that have a workplace culture focused on the growth and development of their employees or contractors are appealing places to work and contribute to staff choosing to remain with the practice setting.
From the perspective of a workplace setting, it can also lead to less overall workplace stress as there is less staff turnover, and it can lead to students seeking out employment opportunities with the practice site after graduation.
3. Reduced stress and anxiety
As mentioned above, the reduction in stress and anxiety by having supportive supervision as part of workplace culture leads to improved mental and emotional health in those who work at the practice site.2,3 The issue of burnout among health professionals is on the rise; giving back to the profession as a supervisor or gaining value from the role you play as a supervisor can be an opportunity for physiotherapists to improve their outlook on their career and day-to-day work life.
As mentioned above, those sites that provide supervision opportunities also have increased rates of staff retention which also has a positive cascade of reducing stress and anxiety in the workplace.
4. Better work environment
I think you will find that many physiotherapists will agree with the fact that students and physiotherapist interns have consistently led to improved cultures in the workplace. New physiotherapists bring a high level of excitement which both clinicians and patients enjoy, as well as new ideas that they can pass on to front-line staff. As mentioned above this can lead to improvements in staff retention- a positive work environment that is supportive of their staff is a place that physiotherapists want to stay at. As physiotherapists move worksites for varied reasons such as family, finances, career opportunities etc. it is recognizable when one transitions from a site that has a supportive culture to one that doesn’t.
5. Increased quality of care delivery
Supervision can be a challenge in the beginning when it comes to time management, but patients almost always enjoy having students around as it means more direct care for them. Being able to assign tasks to a student or having a new PT Intern seeing patients in your practice generally means there are more hands to help out on the practice site. New ideas about care, increased opportunities to review best practice guidelines and potential access to resources and articles can all lead to improvements in the quality of care patients receive.
4 Tips for Improving the Supervision Experience
Historically there has been limited formal training in how to provide supervision of new healthcare professionals, including physiotherapy students and physiotherapy interns.4 So how does one provide quality supervision that leads to better patient outcomes and results in a positive supervisory relationship? Personally, I started supervising students early in my career and had some mentorship from experienced supervisors to help me along in the supervisor role. However, there was no formal training and very little discussion regarding the supervisory relationship or being reflective of my supervision methods. Things have improved since I first supervised a student and hopefully, this next section will provide you with some resources and some strategies to adopt the next time you take on the role of supervisor or are a supervisee.
When physiotherapists decide to take on a supervision role, they should take the time to prepare and consider what will create the best possible experience and what are the potential barriers to providing that experience for the person they are supervising.
- Create an open, supportive, and safe environment.
This seems like an obvious place to start as this applies to learning in almost any environment. Those who feel they are in an open, supportive, and safe place generally tend to thrive as they are free to discuss ideas, express concerns, admit to failures, learn, and grow as a professional. To create that experience or environment it comes down to setting expectations for both the supervisor and supervisee.
One way to achieve that is going through an informed onboarding process5 in which:
- The goals of the supervisory relationship are set.
- The structure needed to reach those goals is put in place (hours per week, direct vs. indirect, opportunities for feedback, etc.)
- The supervisor’s duties and responsibilities are set.
- Commitment to provide honest feedback (both positive and negative)
- Timing of when the feedback occurs with the supervisee, how it will be delivered, and where it will be delivered (in front of the patient or later in a more private setting)
- Commitment to help the supervisee address their learning needs.
- The supervisee’s duties and responsibilities are set (being prepared for meetings with case notes, identifying high-risk clients or situations, self-assessing their performance, and being open to constructive feedback)
2. Establish a supervisory relationship built on trust.
This stems from the first point, as trust in someone’s supervisor is paramount to having an open, supportive, and safe environment. Physiotherapists that focus on therapeutic relationships are focused on building trust with their patients. The same can be said for the supervisory relationship; there should be a priority set on building trust in the first part of the orientation and those first few weeks working together. Trust is built in time and with actions, so it is important to ensure that as a supervisor you follow through with the supervision plan and process you’ve discussed with the supervisee and that you are willing to put work into managing conflict if it arises. Providing constructive criticism and outlining areas of concern are part of the supervision process but there are many ways to convey that message that don’t create a negative supervisory relationship. The managing challenging situations guide6 may assist you in these tasks.
Trust also comes from a recognition of the supervisee as an individual and not just another student or physiotherapist intern. Each individual that comes into a supervisory relationship has multiple individual characteristics and lived experiences. It is important for supervisors to reflect on the identities and lived experiences of supervisees as well as their own, and to acknowledge any biases, prejudices, or preconceptions they may have. Supervisors should take time to review aspects of cultural awareness and humility, power, and privilege, and consider how these factors may affect the supervisee and the development of a trusting supervisory relationship. Once the supervisor has taken the time to review and consider these things it is then their responsibility to seek options to address these factors in a way that is meaningful to both the supervisor and the supervisee.
3. Regular supervision and timely feedback
Direct supervision is always required when a physiotherapist enters a supervisory relationship. As the relationship progresses supervision can move to indirect methods, although it is important to point out that this may not always be the case. If the supervision does move to indirect methods, there must still be ongoing supervision. While there are many ways that indirect supervision can be delivered, it is important that the supervisee feels that they can reach the supervisor when needed and the supervisor is available to them for regular discussions of their goals, to provide feedback, discuss challenging cases, etc. It is important that supervisors continue to fulfill their supervision responsibilities and that even later in the supervisory relationship there are moments of direct supervision to reassess the supervisee in their practice and provide feedback. Being proactive around scheduling and managing workloads is a part of supervision and the supervisor should ensure that they create the time needed to meet with their supervisees.
Timely feedback matters and constantly creating opportunities for that feedback to occur is important. There is a difference in effectiveness when feedback is provided in a timely manner. The supervisee has the interaction fresh in their head and can implement changes before the next interaction with that client. There should also be no surprises in the evaluation for supervisees as both positive and negative feedback should be ongoing through their placement. For physiotherapist interns, there should be continuous regular feedback in the form of regular meetings even if there is no formal documentation required regarding their progress.
4. Training for supervisors
Taking the time to reflect on your supervision process before and during supervision is important. The physiotherapist supervisor should think about the supervisee’s perspective, what they bring to the relationship, and what their potential needs are as a clinician and as a person. Evaluation and growth as a supervisee occur in both technical and non-technical skills. Therefore, opportunities should be taken to evaluate and provide feedback on things such as professionalism and cultural awareness along with ethical, legal and regulatory concerns.
For the supervisor to improve their supervisory skills, feedback from the supervisee and others in the workplace is imperative. Just as we reflect on our clinical practice, we should take the time to reflect on our supervisory practice. Those who supervise should encourage their supervisees to provide feedback even if there are fewer formal ways to do so outside of student placements. For those of you supervising, you should keep in mind the power imbalance that exists between you and your supervisee. It may be difficult for them to provide honest feedback, so it is another positive of enabling a more open honest supervisory relationship. The “just-wing-it” approach is not the best approach when it comes to supervision.
Although we have been focusing on how to build a positive supervisory relationship that creates better outcomes for all those involved, including the patient, it is worth discussing negative supervisory relationships and what occurs when there is a breakdown in trust. A negative supervisory relationship is not about providing or receiving negative feedback or performance evaluations. Being supervised is about getting a better understanding of your technical and non-technical skills as a physiotherapist. To do so, an honest evaluation of those skills must occur. The supervisee should be provided with feedback on both the positive and negative aspects of their performance as well as strategies to improve. If the supervisee is not meeting the standards set out, it is the supervisor’s responsibility to identify the issue so that it can be addressed properly.
That being said, negative supervisory relationships can exist and several years ago, work was done in Alberta to address bullying and coworker abuse in the health care setting. You can access the video catalogue and webinar here to understand better what workplace bullying and abuse can look like.
It is important to recognize these behaviours and address them through appropriate channels when they occur in the workplace.
You can find some other, free resources to assist you in your growth as a supervisor here:
The Canadian Physiotherapy Assessment of Clinical Performance Online Learning Module
https://app.rehab.utoronto.ca/ACP2.0/story_html5.html
Donna Drynan provides 10 +1 Reasons to Take a Student
https://caot.in1touch.org/document/5181/reasons.pdf
Preceptor Education Programs
https://canvas.ubc.ca/courses/97719
References
- Martin P, Kumar S, Lizarondo L. When I say … clinical supervision. Med Educ. 2017 Sep;51(9):890-891. doi: 10.1111/medu.13258. Epub 2017 Feb 17. PMID: 28211080.
- 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 Sep 28;11(9):e052929. doi: 10.1136/bmjopen-2021-052929. PMID: 34588261; PMCID: PMC8479981.
- Priya Martin, Saravana Kumar, Esther Tian, Geoff Argus, Srinivas Kondalsamy-Chennakesavan, Lucylynn Lizarondo, Tiana Gurney, David Snowdon, Rebooting effective clinical supervision practices to support healthcare workers through and following the COVID-19 pandemic, International Journal for Quality in Health Care, Volume 34, Issue 2, 2022, mzac030, https://doi.org/10.1093/intqhc/mzac030
- Rees CE, Lee SL, Huang E, Denniston C, Edouard V, Pope K, Sutton K, Waller S, Ward B, Palermo C. Supervision training in healthcare: a realist synthesis. Adv Health Sci Educ Theory Pract. 2020 Aug;25(3):523-561. doi: 10.1007/s10459-019-09937-x. Epub 2019 Nov 5. PMID: 31691182; PMCID: PMC7359165.
- Clay, RA. How to be a better supervisor for students in health service. Monitor on Psychology. 2017 Sep 48;8(34)
- The College of Physiotherapists of Alberta: Managing Challenging Situations Guide. https://www.cpta.ab.ca/for-physiotherapists/resources/guides-and-guidelines/managing-challenging-situations-guide/
