Continuity of supervision: Does it mean what we think it means?

Abstract

Context Continuity of supervision (CoS) is generally accepted as an important element of competency‐based medical education (CBME). However, collecting and interpreting evidence for its effectiveness are a challenge because we lack a shared understanding of CoS. Translating the available evidence about CoS into practice is an even greater challenge because the evidence largely exists in the undergraduate medical education (UME) literature, whereas literature about CBME is mostly situated in postgraduate medical education (PGME). Proposal We explore the potential dangers of basing assumptions of the importance of CoS in CBME on evidence from the UME level where CBME is yet to be widely implemented. First, we discuss current understandings of what is meant by CoS and examine some of its evidence and where such evidence comes from. Next, we consider relevant theories related to CoS in the context of CBME and review how it is conceptualised in different educational models. We then discuss some contextual and pedagogical differences between UME and PGME when CoS is considered. Finally, we propose a shared understanding of CoS and outline implications and next steps to determine if the benefits of CoS seen at the UME level will also manifest with PGME learners. Conclusions We have the opportunity to undertake research to close our gap in knowledge about CoS at the PGME level using data emerging from our experiences with CBME. Selecting specific dimensions of CoS will allow research that is necessary to determine that what works at the UME level will also work at the PGME level as we continue to march towards CBME.

How progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships: a mixed method study

“…However, there are conflicting perspectives and evidence on the effects of supervisor-trainee relationships on assessing performance. These relationships can make assessments either more accurate or increase rater bias (de Jonge et al, 2017;Lee & Ross, 2020;Schut et al, 2021). For supervisors, it can be challenging to combine the (potentially) conflicting roles of educator and assessor (Govaerts et al, 2019;Jackson et al, 2019;Schut et al, 2021).…”

“…Supervision can be defined as the provision of monitoring, guidance, and feedback on matters of personal, professional, and educational development in the context of patient care (Kilminster & Jolly, 2000). In order to contribute to the learning, assessment, and patient safety goals of the educational program, supervisors take up multiple roles as educator, assessor, mentor, and coach (Lee & Ross, 2020;Mellon & Murdoch-Eaton, 2015;Sawatsky et al, 2020;Schut et al, 2021). These roles can strengthen each other, but can also be conflicting.…”

“…In postgraduate healthcare education, supervisors and trainees often only work together for a brief period of time, which can make the exchange of assessment information less effective (Schut et al, 2021). In primary care settings, such as the general practice and the community pharmacy, longitudinal supervisory relationships are more common (Jackson et al, 2019;Lee & Ross, 2020;Westein et al, 2019). Continuity of supervision has potential benefits for assessment: earlier identification of learners in difficulty, creating opportunities for trust, and providing greater patient care responsibilities (Lee & Ross, 2020).…”

Relationships, continuity and time in health professions education

“…3 It would be interesting to further explore these factors in the learning conversations that were observed, particularly given the literature about the potential importance of time and continuity of teacher-learner relationships. 5 For example, there is research at the undergraduate level that demonstrates that longitudinal relationships between teachers and learners offer benefits to the trainee for learning and assessment compared with briefer block rotations. Over time, students in year-long longitudinal integrated clerkships report that they become more comfortable in their learning when they perceive themselves as part of a partnership while preceptors report viewing their students as junior colleagues.…”

“…Welink and colleagues mention that the participants differed in stage of training, level of experience and length of collaboration, but they did not include these factors in their analyses 3 . It would be interesting to further explore these factors in the learning conversations that were observed, particularly given the literature about the potential importance of time and continuity of teacher‐learner relationships 5 . For example, there is research at the undergraduate level that demonstrates that longitudinal relationships between teachers and learners offer benefits to the trainee for learning and assessment compared with briefer block rotations.…”