Sue Kilminster

Bio: Sue Kilminster is an academic researcher from University of Leeds. The author has contributed to research in topics: Professional development & Clinical supervision. The author has an hindex of 16, co-authored 28 publications receiving 2088 citations. Previous affiliations of Sue Kilminster include Northern General Hospital & University of Sheffield.

Effective supervision in clinical practice settings: a literature review

Abstract: Context Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective. Purpose To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision. Content The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness. Conclusions The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.

AMEE Guide No. 27: effective educational and clinical supervision

Abstract: Background: This guide reviews what is known about educational and clinical supervision practice through a literature review and a questionnaire survey It identifies the need for a definition and for explicit guidelines on supervision There is strong evidence that, whilst supervision is considered to be both important and effective, practice is highly variable In some cases, there is inadequate coverage and frequency of supervision activities There is particular concern about lack of supervision for emergency and ‘out of hours work’, failure to formally address under-performance, lack of commitment to supervision and finding sufficient time for supervision There is a need for an effective system to address both poor performance and inadequate supervision Supervision is defined, in this guide as: ‘The provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee’s experience of providing safe and appropriate patient care’ A framework for effective supervision is provided: (1) Effective supervision should be offered in context; supervisors must be aware of local postgraduate training bodies’ and institutions’ requirements; (2) Direct supervision with trainee and supervisor working together and observing each other positively affects patient outcome and trainee development; (3) Constructive feedback is essential and should be frequent; (4) Supervision should be structured and there should be regular timetabled meetings The content of supervision meetings should be agreed and learning objectives determined at the beginning of the supervisory relationship Supervision contracts can be useful tools and should include detail regarding frequency, duration and content of supervision; appraisal and assessment; learning objectives and any specific requirements; (5) Supervision should include clinical management; teaching and research; management and administration; pastoral care; interpersonal skills; personal development; reflection; (6) The quality of the supervisory relationship strongly affects the effectiveness of supervision Specific aspects include continuity over time in the supervisory relationship, that the supervisees control the product of supervision (there is some suggestion that supervision is only effective when this is the case) and that there is some reflection by both participants The relationship is partly influenced by the supervisor’s commitment to teaching as well as both the attitudes and commitment of supervisor and trainee; (7) Training for supervisors needs to include some of the following: understanding teaching; assessment; counselling skills; appraisal; feedback; careers advice; interpersonal skills Supervisors (and trainees) need to understand that: (1) helpful supervisory behaviours include giving direct guidance on clinical work, linking theory and practice, engaging in joint problem-solving and offering feedback, reassurance and providing role models; (2) ineffective supervisory behaviours include rigidity; low empathy; failure to offer support; failure to follow supervisees’ concerns; not teaching; being indirect and intolerant and emphasizing evaluation and negative aspects; (3) in addition to supervisory skills, effective supervisors need to have good interpersonal skills, good teaching skills and be clinically competent and knowledgeable

Women in medicine − is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine

Abstract: BACKGROUND Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession. AIMS The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession. CONCLUSIONS This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.

Preparedness is not enough: understanding transitions as critically intensive learning periods

Abstract: Objectives: Doctors make many transitions whilst they are training and throughout their ensuing careers. Despite studies showing that transitions in other high risk professions such as aviation have been linked to increased risk in the form of adverse outcomes, the effects of changes on doctors’ performance and consequent implications for patient safety have been under-researched. The purpose of this project was to investigate the effects of transitions upon medical performance. Methods: The project sought to focus on the inter-relationships between doctors and the complex work settings into which they were transitioning. To this end, a ‘collective’ case study of doctors was designed. Key transitions for Foundation Year and Specialist Trainee doctors were studied. Four levels of the case were examined: the regulatory and policy context; employer requirements; the clinical teams in which doctors worked; and the doctors themselves. Data collection included interviews, observations and desk-based research.. Results: We identified a number of problems with doctors' transitions that can all adversely affect performance. A) Transitions are regulated but not systematically monitored. B) Actual practice (as observed and reported) was determined much more by situational and contextual factors than by the formal (regulatory and management) frameworks. C) Trainees’ and health professionals’ accounts of their actual experience of work showed how performance is dependent on local learning environment. D) We found that the increased regulation of clinical activity through protocols and care pathways helps trainees’ performance whilst the less regulated aspects of work such as rotas, induction and multiple transitions within rotations can impede the transition. Conclusions: Transitions may be reframed as critically intensive learning periods (CILPs) in which doctors engage with the particularities of the setting and establish working relationships with doctors and other professionals. Institutions and wards have their own learning cultures which may or may not recognise that transitions are CILPS. The extent to which these cultures take account of transitions as CILPs will contribute to the performance of new doctors. There are therefore implications for practice, and for policy, regulation and research.

Strategic planning in medical education: enhancing the learning environment for students in clinical settings

Abstract: Background The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. Purpose This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. Method A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. Results Twenty different issues were identified, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with 'survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning efficiency. Conclusions The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a 'community of practice' and enhance their capacity for self-regulated practice.

A best evidence systematic review of interprofessional education: BEME Guide no. 9

Abstract: Background and review context: Evidence to support the proposition that learning together will help practitioners and agencies work better together remains limited and thinly spread. This review id...

Fifty years of the critical incident technique: 1954-2004 and beyond:

Abstract: It has now been 50 years since Flanagan (1954) published his classic article on the critical incident technique (CIT) - a qualitative research method that is still widely used today This article reviews the origin and evolution of the CIT during the past 50 years, discusses CIT’s place within the qualitative research tradition, examines the robustness of the method, and offers some recommendations for using the CIT as we look forward to its next 50 years of use The focus of this article is primarily on the use of the CIT in counselling psychology, although other disciplines are touched upon