Reflection on what clinical supervision means to me.
Clinical supervision can be defined as a conversation between professionals at all levels of experience, aimed at promoting learning, reflective practice and improving patient safety and the quality of patient care (NHS London Faculty of Deanery). The word `supervision’ indicates an act of over-seeing, looking over somebody’s shoulder to check on what he is doing. It includes both aspects of development and performance.
On the first day of our intensive mode session on clinical supervision, Prof Steve Trumble elaborated on the model of skills acquisition by Dreyfus and Dreyfus (1986). When he later instructed us to draw our own masterpiece, depicting our basic understanding of clinical supervision, I was thinking of the Russian babushka dolls. The prettiest and most decorated doll would be the biggest, which contained the other five dolls – hence the `master’ in performing the skill. The novice is the smallest doll, which are supervised by the other five bigger dolls – most immediately by the advanced beginner. (refer Diagram 1)
The power gaps between the novice and the master is too far and wide. I wonder whether the novice could bypass the other four bigger dolls and have direct access to the master, without stepping on other people’s toes. Could the master simply bring himself down to supervise the novice or the advanced beginner? From my own experience so far, the relationship between the `dolls of clinical supervisors’ has always been somewhat hierarchal, domineering and paternalistic.
We were later instructed to explain our masterpiece in details to a partner. I paired up with Kate Davey and listened to her brief explanation on her abstract masterpiece. Kate was obviously excited to see my babushka dolls. She challenged my view and proposed a different perspective. Kate indicated that the position of the dolls should be reversed – the master being the smallest while the novice should be represented by the biggest, prettiest doll. She was looking from the level of support to individuals in the different ranks of competencies. The master and expert would be the loneliest with minimal support around them, while the novice’s learning needs and requirements would be fully supported by his supervisors. According to Kate, the babushka dolls should be arranged like this (refer Diagram 2) :
Dreyfus model of skill acquisition could be seen from many angles and perspectives. The model was challenged by Pena A. (2010). He proposed that the acquisition of clinical skills is much more complex and could not be explained directly by Dreyfus model which depends on implicit knowledge and intuition. Clinical skills which embedded explicit as well as implicit knowledge, depend upon sound analytical and empirical data. Pena insisted that unlike the highly competent expert described in Dreyfus model who were mainly intuitive, the clinical expert attained high level of performance through working intuitively, reflectively and analytically.
As for me, I could see why and how clinical supervision plays a pivotal role in the field of clinical teaching. Inevitably, the degree of competencies of any medical doctor would depend heavily on the quality as well as quantity of the clinical supervision he had, is having and will have in the future.