Clinical Supervision Guidelines

Trainees must be directly supervised for at least 25 cases, or more if the supervisor is of the opinion that more direct supervision in needed.  These cases must include all aspects of running the HLM/ECLS pump (initiation of bypass, weaning, etc).  Cases where this does not occur cannot be counted in the trainee case log.  All ECLS cases covering initiation onto or weaning from support must be directly supervised.  Trainees must not do ECLS shifts unsupervised (see 1.4 and 5.1).  Standby bypass or ECLS cases can be indirectly supervised, if bypass or ECLS is needed the standard supervision requirement applies.

Health Workforce Australia’s Clinical Supervision Support Framework (HWA 2011, p.4) defines ‘clinical supervision’ as: ‘the oversight – either direct or indirect – by a clinical supervisor of professional procedures and/or processes performed by a student or a group of students within a clinical placement for the purpose of guiding, providing feedback on, and assessing personal, professional and educational development in the context of each student’s experience of providing safe, appropriate and high-quality patient care.’

Benefits of Clinical Supervision

Particular requirements must be met in order for clinical supervision to bear fruit for workers and the organisations employing them; specifically, clinical supervision must be accessible, regular, and consistent and must be provided by clinical supervisors who have the necessary experience, skills and knowledge to meet the demands of the work.

Effective clinical supervision that is perceived by workers to be at least satisfactory, or of high quality, benefits them, their organisations and their clients in the following ways.

It:

  • aids trainees’ acquisition of complex clinical skills, expands their clinical practice and increases their competence and confidence
  • fosters professional development of perfusionists at all experience levels
  • is associated with higher levels of job satisfaction or morale
  • potentially improves communication and team cohesion among cardiac O.R. teams
  • promotes development of specified skills and competencies, to bring about measurable outcomes
  • raises level of accountability in services and programs
  • provides a mechanism by which consistency in treatment modalities and other service delivery standards can be established across the organisation
  • ensures patient welfare, in relation to clinical safety and competence, professional and ethical standards and organisational service delivery protocol, thereby functioning as a risk-management tool.

“Clinical Supervision, especially when it is professionally led, learner-centred, educational and supportive, has great potential. It fosters a culture that is educational, self-critical, outward-looking and patient-focused, centred on patient safety and quality care.”

Tomlinson J 2015, Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis. BMC Medical Education, 15, 103.

ABCP Clinical Supervision Policy:

Policy Statement

1.1            The ABCP accredited Training Institution must be committed to providing clinical supervision for all trainee staff. Clinical supervision is to be adaptable and relevant to profession and service components within the service.

1.2            Clinical supervision will provide trainees with the opportunity to develop and improve clinical skills, thus enhancing work satisfaction, reducing work stress and giving patients the best possible care.

1.3            The provision of clinical supervision to trainees will be equitable, systematic and responsive to supervision needs.

1.4            The Training Institution is to ensure that all trainees have access to relevant direct or indirect supervision by suitably qualified and experienced supervisors for every case undertaken as a trainee.

Rationale

2.1          Clinical supervision occurs within ABCP and Training Institution frameworks to promote quality clinical practice, professional standards and competencies.

Outcome Standards/Performance Indicator/s

3.1          All trainees who have clinical contact with patients must have access to supervision.

3.2.         All supervision is provided by qualified and experienced practitioners.

3.3.         Supervision between supervisors and trainees will be planned.

3.4.         The quality of clinical practice and the professional needs of trainees are identified and monitored.

3.5.         Supervision will contribute to the development of professional standards of service provision to patients.

Evaluation Method

4.1.         Records will be kept to monitor the trainees receiving supervision, and the degree of supervision received.  This will be as part of the trainee 200 case log.

4.2          After every 50 cases an evaluation must be conducted by the trainees and supervisors to review the supervision process and clinical practice progress made.  These evaluations will be forwarded to the ABCP Course Coordinator.

Key Principles

5.1          Clinical supervision is defined as a form of supervision by a person with specific expertise in clinical practice. This is distinguished from line management and peer supervision.  “Direct Supervision” means a supervising perfusionist is physically present in the location where the trainee perfusionist is performing routine clinical functions.  “Indirect Supervision” means the supervising perfusionist is not in the physical location of the trainee but must be in close proximity to, and available to go to, that location immediately should the need arise.  (Not doing a case in one theatre while supervising a trainee in another theatre.)

5.2          All trainees must have access to supervision on an individual basis while completing the ABCP SCiCP.

5.3          Functions of Clinical Supervision will include:

Review and assessment of clinical work.

Clinical Feedback.

Problem Solving.

Setting Clinical goals.

Education and Professional Development.

Support.

5.4          Supervision should be focussed on client issues. If personal issues are of concern to either trainee or supervisor, the other forms of support need to be considered.

Trainees

6.1          All trainees are responsible for:

Maintaining an ongoing commitment to clinical supervision and incorporating it into their work practice.

Knowing who their supervisor is on a case by case basis.

Initiating clinical discussion, when required, with the case supervisor.

Ensuring supervision arrangements are reviewed and assessment is undertaken as required by the ABCP.

Supervisors

7.1          Supervisors are responsible for:

Discussing the clinical supervision arrangement with the trainee on a case by case basis.

Utilising the principles of ethical practice with respect to confidentiality and accountability. Confidentiality can be breached if the supervisor has sufficient concerns about a trainee’s practice and the issue cannot be resolved with the trainee.

Maintaining professional development and practice that is required to provide quality clinical supervision.

Managers

8.1          Managers are responsible for:

Ensuring all trainees are aware of policy and procedures and have access to clinical supervision.

Arranging and approving all supervision requirements.

Reviewing and discussing supervision arrangements as required.

Providing information on available supervisors to trainees.

Trainee Outcome Evaluation must assess the following:

  • Communication, morale, teamwork
  • Work role
  • Knowledge of Perfusion
  • Confidence in the operating theatre
  • Attitude towards patients
  • Perfusion skills
  • Working with other craft groups
Being the best supervisor you can be:

Building a positive relationship with your trainee includes:

Being Available – schedule meeting times with your trainee, touch base with them regularly and stop to listen when they approach you outside of supervision.

Being Aware – supervisors need to be aware of the trainee’s level of competence, scope of practice, what their learning style is and what the trainee’s learning objectives are.

Being Organised – make the most of the little time there is for clinical supervision activities by being organised and prepared.

Being Empathetic – remember that we all started as learners and that everyone has a first time that can make them nervous and anxious. Use this insight to support and understand your learner.

Showing Respect – regardless of any individual differences (such as age, gender, race, religion, sexual orientation or other) and regardless of the level of experience respect should form the basis of the supervisory relationship.

Developing Trust – show confidence and a degree of trust in your trainee, allow them some autonomy to seek learning opportunities and activities that interest them.

Setting Expectations – setting clear expectations and objectives prevent uncertainty, frustration and resentment which can all cause breakdown of a positive relationship.

Maintaining Confidentiality – trainees will feel more comfortable confiding in you about matters of a more sensitive nature, and be honest about errors or lack of capability if they know it is in confidence. However, disclosure of confidential matters should be escalated to management when there are serious concerns or breaches of policy and protocol.

Being Friendly and Approachable – trainees that feel comfortable and happy in the company of their supervisor are more likely to communicate with and learn from their supervisor.

Setting Boundaries – ensuring clear boundaries help to minimize stress and conflict in the supervisory relationship and it is important to let the trainee know what is and isn’t acceptable behaviour, practice, conduct, topic for discussion (i.e. personal matters).

Providing Explanations – setting rules or giving instruction without explanation can be confusing and discouraging for your trainee if they do not fully understand the rationale or implications.

Being Supportive and Positive – encouragement and enthusiasm from the supervisor promotes an honest collaborative supervisory relationship.