'Hands on, Hands off': a model of clinical supervision that recognises trainees' need for support and independence

Abstract

Supervision must be both structured and dynamic. Besides providing a regular forum for discussion and reflection, supervision must accommodate the variable needs of individual junior doctors and navigate between being hands-on and hands-off. Such dynamic approach is necessary to reassure junior doctors they are in a 'zone of safe learning' where they can act with adequate and flexible support and negotiate changes in supervisory attention.

Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature

“…However, engagement or even permission to enter and engage in activities requires the provision of an escape or safe ‘space’ for the student to retreat to when they feel overwhelmed . This concept is recognised as the supervisor's ability to rescue the student and described as the ability to ‘step in’ or step out . Importantly, this ability protects the client from unintentional harm .…”

“…84 This concept is recognised as the supervisor's ability to rescue the student and described as the ability to 'step in' 32 or step out. 12,32,56,85 Importantly, this ability protects the client from unintentional harm. 86 Conversely, supervisors also require the understanding, timing and capacity to let the student 'go' as an independent clinician.…”

Participation and progression: new medical graduates entering professional practice

“…A formal articulated understanding of the need for staged responsibility and support would assist in ensuring that first rotations are well rather than poorly supported, particularly by registrars. Iedema et al's (2010) 'hands on hands off' model of clinical supervision provides a useful guide for postgraduate educators as it provides a framework balancing support and responsibility.…”

‘Sometimes the work just needs to be done’: socio-cultural influences on direct observation in medical training

“…When a culture and its learners value independence and autonomy, these expectations may be at odds with calls for greater use of direct observation. Recognising the need to balance autonomy with supervision, Iedema et al . called for a dynamic approach to supervision, moving from ‘hands‐on’ to ‘hands‐off’ in concert with the abilities of the learner.…”