Cases, contexts and careers
Clinical supervision can be helpful in cases where there is no easy answer, for example:
- where there are ethical issues
- where decision making is complex because of the interaction of clinical/social and psychological factors
- when it is unclear how to proceed with or stop investigations or treatment
- where the clinician is dealing with angry, distressed, unlikeable patients or their families
- in handling complaints or significant events
- where patients present with somatisation, conditions where there is no clear diagnosis or patients who attend frequently.
The educational supervisor needs to be able to take account of clinical cases as part of their work with student or trainee, and also know to whom the learner can be referred to discuss specific clinical issues that may require more technical or expert knowledge. It may be that the learner identifies particular educational needs through working with certain patients, families or colleagues, and these can be addressed through the learning contract. The educational supervisor can also advise on areas suitable for assessment or where further practice or experience is needed.
Clinical scenarios depend on the place in which they occur, the players involved and the interactions between these people. It is also important to think about the reason for carrying out the supervision: who has asked for it and for what purpose? Some examples of the importance of thinking about context are:
- where there are professional or inter-professional rivalries
- where there are communication problems
- where there are difficulties in teamwork
- where there are issues about roles and boundaries
- where clinicians may have different expectations from patients and their families
- when problems seem to revolve around issues such as power, money or politics.
Here, the role of the educational supervisor involves understanding of the various contexts in which the supervisee is working, and offering support in terms of how needs relate to learning, professional development and being able to meet identified objectives. The educational supervisor may also be able to mediate or discuss issues with other colleagues (with the agreement of the learner) in order to help meet the supervisee’s learning needs.
Again, the supervisor may also provide support in terms of ensuring that the contexts in which the trainee or student is working are appropriate for meeting specified educational objectives and assessment needs.
Supervision conversations can often raise issues about careers, for example:
- the need for further training
- conditions at work
- job prospects and career aspirations, including retirement
- ideas about how to manage and delegate work.
This is where the role of the educational supervisor is much clearer and where the educational supervision role is key. One of the main tasks in educational supervision is to support the learner on their ‘learning journey’. Each supervisee’s ‘journey’, although having elements in common with that of other students or trainees, will be unique to that person. The supervisor therefore needs to understand the strengths, areas for improvement/development and aspirations of each supervisee in order to provide effective and timely supervision.