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The Superguidea guide for supervising oral health professionalsJune 2013 | FIRST EDITION

Health Education and Training Institute (HETI)Building 12Gladesville HospitalGLADESVILLE NSW 2111Tel: (02) 9844 6551Fax: (02) 9844 6544www.heti.nsw.gov.auinfo@heti.nsw.gov.auPost: Locked Bag 5022, GLADESVILLE NSW 1675National Library of Australia Cataloguing-in-Publication entryTitle:The Superguide: a guide for supervising oral health professionals/Health Education and Training Institute.ISBN: ISBN 978-1-74187-837-0Subjects: Oral health personnel--Supervision of--Australia--Guides, manuals, handbook, etc.Medical education--Australia.Other Authors/Contributors: Health Education and Training Institute. Dewey Number: 610.727069Suggested citation:Health Education and Training Institute 2013, The Superguide: a guide for supervising oral health professionals,HETI, Sydney.This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to theinclusion of an acknowledegment of the source. It may not be reproduced for commercial usage or sale.Reproduction for purposes other than those indicated requires written permission from HETI.© HETI June 2013For further copies of this document, please contact HETI,or download a digital copy from the HETI website: www.heti.nsw.gov.auHETI The SuperguideFIRST EDITION

The Superguidea guide for supervising oral health professionalsJune 2013 | FIRST EDITIONFIRST EDITIONHETI The Superguide1

ForewordForewordMy twenty years in the public health system have taught me the importance of quality clinical supervisionfor excellent patient care and for development of health professionals at every stage of their careers.Being a clinical supervisor is both rewarding and challenging and the role of the Health Education and TrainingInstitute (HETI) is to support you as you undertake this responsibility.I am glad to introduce the Superguide: a guide for supervising oral health professionals, developed with the helpof the Oral Health Superguide Working Group in partnership with HETI through the funding assistance extendedby Health Workforce Australia under the Clinical Supervision Support Program.It is my hope that this document will provide fresh, practical and relevant information that you can applyin your day-to-day practice.The Superguide will be useful for:• Browsing through to gain a concise but comprehensive understanding of the key elements of clinical supervision• Dipping in and out of when you need a reminder on the best way to go about a task (e.g. giving feedbackor teaching in the presence of patients)• Downloading, pulling out or photocopying resources for yourself, your fellow supervisors and your supervisees• Using as a resource to develop training for clinical supervisors in oral healthOn behalf of HETI, I would like to take this opportunity to thank all clinical supervisors for your commitmentto excellent health care delivery and the development of the oral health profession.Heather GrayChief ExecutiveHealth Education and Training Institute2 HETI The Superguide FIRST EDITION

ForewordClinical supervision is essential in ensuring the promotion of excellence in clinical practice and of patient safety.Good clinical supervision positively impacts on the clinician or student being supervised and has been shownto improve patient outcomes. Supervisors play a central role in setting learning priorities and the culture for learningwithin health care settings. Supervisors have many demands on their time, so staged implementation and extensivepiloting are necessary to create a sustainable training program to suit their needs.The NSW public oral health system plays an important role in the education and training of dental and oral healthstudents by providing placements in public clinics and the two major dental hospitals. NSW Health is committedto quality student clinical placements and the provision of well-trained and committed clinical supervisors.Over the past five years the NSW Centre for Oral Health Strategy has worked with universities and Local HealthDistricts to expand clinical placement facilities in rural and regional NSW as well as in metropolitan locations.Clinical supervision encompasses the ability to influence not only the supervisee’s clinical skills, but also the waythey think about and approach dental matters. We can all remember our standout clinical supervisors at university,but we can also remember those we would prefer to forget. This should encourage each and every clinicalsupervisor to seek out resources and opportunities, to support themselves throughout their career.Supervisors are always busy. This publication provides supervisors with a plain English, user friendly resourcewhich includes useful case studies and practical templates.The Oral Health Superguide also fills a need for a comprehensive resource for those who supervise oral healthstudents, as well as those more experienced oral health professionals moving into an unfamiliar area of practiceor returning to clinical work after an extended absence.The value of the Oral Health Superguide is that it can be used as an ongoing resource to equip clinical supervisorswith the skills and practical strategies required at various stages of their careers. I am sure it will be an invaluableresource to oral health clinicians as it is presented in a well-structured format that allows ease of access.Dr Kerry ChantDeputy Director General Population and Public Healthand Chief Health Officer, NSW Ministry of HealthFIRST EDITIONHETI The Superguide3

AcknowledgementsAcknowledgementsThe Superguide was adapted from ‘The Superguide – a handbook for supervising doctors in training’,First edition, November 2010, written by Craig Bingham and Dr Roslyn Crampton, and ‘The Superguide – ahandbook for supervising allied health professionals’, Second edition, April 2012, written by The SuperguideSteering Committee.We would like to acknowledge the oral health professionals who played a role in the development of this guidethrough reviews, case studies, contributions, and ‘Voices from the field’.The development of the Superguide was made possible through funding received from HWA as part of theClinical Supervision Support Program (CSSP).This guide was developed on behalf of HETI by Endeavour Training and Development Pty Ltd.This project was possible due to funding made available by Health Workforce Australia.4 HETI The Superguide FIRST EDITION

ContentsContentsForeword.................................................................2Acknowledgements................................................4Who this guide is for...............................................7About this guide......................................................8The scope of clinical supervision ...........................9The Supersummary................................................10What is clinical supervision?.............................. 13What is clinical supervision?...................................14Functions of clinical supervision.............................16Who provides clinical supervision? .......................18Governance and clinical supervision......................19Methods of clinical supervision..............................20Supervision in rural and remote settings................23Effective clinical supervision.............................. 25Skills of an effective supervisor..............................26Reflective practice..................................................28Barriers to effective supervision.............................29Checklist for effective clinical supervision..............30Responsibilities of the supervisee..........................31The educational role........................................... 33The clinical supervisor’s educational role...............34Promoting a culture of lifelong learning..................35Reflective practice..................................................35Facilitating the learning process.............................36Top ten tips for the teaching supervisor.................37Developing skills in teaching and education..........39Reflective practice..................................................39Learning styles........................................................40Reflective practice..................................................40Identifying different learning styles.........................42What constitutes effective clinical teaching?.........43Identifying opportunities for clinical teaching.........44Developing clinical skills.........................................45Case study........................................................46SNAPPS..................................................................47Teaching in the presence of patients......................48Case study........................................................49Teaching during case discussion............................50Teaching by guided questioning.............................50Teaching using the treatment plan..........................51Formal teaching......................................................52Teaching remotely...................................................53Critical responses...................................................53Teaching non-clinical skills.....................................54The supportive role............................................ 55The supportive role of the supervisor.....................56Tips to foster engagement of the supervisee.........57Common challenges for supervisors......................58Stress management................................................60Managing a supervisee in difficulty........................61Process for managing a supervisee in difficulty.....62Steps in a crucial conversation...............................63FIRST EDITIONHETI The Superguide5

ContentsThe administrative role....................................... 69Clinical supervision and operational management.....70Managing clinical staff............................................71Key tasks................................................................71Orientation..............................................................72Performance development and review...................74Mentors, coaches and buddies..............................75The supervisor’s toolkit – activities................... 77Resources for supervision......................................78Establishing the supervisory relationship...............79Getting to know your supervisee’s skill level..........80Supervision contract...............................................81Documenting supervision sessions........................82Evaluating supervision............................................83Active supervision...................................................84The supervisor’s toolkit – handouts................... 103Developing communication skills ..........................104Time management .................................................106Smart goals.............................................................107Problem solving model...........................................108Stress management................................................109The supervisor’s toolkit – templates.................. 111Supervision contract...............................................113Supervision session record....................................117Supervision log.......................................................119Supervision feedback form.....................................121SMART goals..........................................................123Problem solving......................................................125Reflective practice..................................................127Agenda template example......................................129A key concept: hands-on, hands-off......................85Risk management...................................................87Communication skills..............................................88Reflective practice..................................................89Case study........................................................90Reflective practice..................................................91Case study........................................................92Providing feedback.................................................94Reflective practice..................................................95Case study........................................................96Smart goals.............................................................98Examples of SMART goals.....................................99Problem solving......................................................100Fostering interprofessional collaborative practice..1016 HETI The Superguide FIRST EDITION

Who this guide is forWho this guide is forThis guide is intended for clinical supervisors acrossthe range of different practitioners that make up theoral health team in both public and private settingsthroughout NSW including:• dental assistants• dental hygienists• dental prosthetists• dental specialists e.g. periodontists, endodontists,prosthodontists, oral surgeons, etc.• dental technicians• dental therapists• dentists• oral health therapistsClinical supervision is experienced by:• students• new graduates• new specialists• clinicians returning to practice after extended breaks• clinicians moving from overseas• those moving into new and unfamiliar areasof practice (for example a clinician who has previouslyonly worked with adults now working with children)• staff introduced to new procedures or techniques.Peer clinical supervision can also be usefulfor all oral health practitioners who want to continuallybuild on their professional knowledge and skills.FIRST EDITIONHETI The Superguide7

About this guideAbout this guideHETI has produced this guide in response to the numerous requests from people involved in supervising oralhealth professionals for a simple and practical guide to clinical supervision. We hope this guide can help generateinterest in enhancing skills and knowledge of clinical supervision in the oral health field, and thereby lead togreater professional satisfaction and, above all, quality patient care. This guide has been adapted from previousSuperguides to be relevant to the needs of those working in oral health.We hope you can use this guide as a practical resource to improve the effectiveness of clinical supervision.It gives information, tips and suggestions based on the published evidence and the knowledge of many experiencedsupervisors. It is not intended to be prescriptive and it is not a policy document.While clinical supervisors are generally involved in teaching and training to facilitate professional developmentand competence in clinical practice, they also have a supportive role to play. Supervisors are often responsible forguiding supervisees in the administrative functions of the profession. This guide therefore provides information toequip clinical supervisors with practical strategies to facilitate the acquisition of skills and knowledge across theseareas. It provides information about:• supervising oral health professionals in ways that contribute to the safety and better care of patients;• effective methods of contributing to the education, welfare and professional development of oral healthprofessionals.It is acknowledged that the way clinical supervision is carried out varies across the oral health disciplines andacross practice settings. In addition, it is important to recognise that each discipline has its own requirements forregistration and continuing professional development.This guide is not intended to override any professional requirements.We have tried to make this guide as inclusive as possible for oral health practitioners across the different areasof practice and at all levels of experience. It is intended to be an accessible resource that can either be read fromstart to finish or dipped into for practical tips and ideas at the point of need. We have produced both hardcopy andelectronic versions to make it even more accessible. Both have graphic elements to highlight key points and theelectronic version has links to make it easier to find the information you are seeking.This document should be used in conjunction with existing discipline specific supervision requirements andworkplace policies.This guide, updates and other useful resources are available on the HETI website.8 HETI The Superguide FIRST EDITION

The scope of clinical supervisionIn oral health, most clinical supervision occurs at the student and early career stages. This guide is intended to beuseful for clinical supervisors of those gaining professional accreditation as new practitioners or when moving into anew specialised area of practice. We also expect this guide to be helpful for clinical supervisors of those re-training,e.g. after a prolonged absence from the profession or when moving from overseas.The scope of clinical supervisionHowever, we aim to get you thinking of clinical supervision more broadly than that. Clinical supervisioncan be an ongoing process throughout your career, regardless of your area of professional practice or level ofclinical experience.Throughout this guide we provide case studies and examples of supervisory practice. You will note that someof these may seem more applicable to the supervision of a student or junior oral health professional, or to thebeginning supervisor. However, there are times when the supervisor of a more experienced practitioner may needto draw on these skills, for example when supervising a clinician moving into a previously unfamiliar area of practiceor when introducing a new procedure or technique. Furthermore, there are times throughout any career when thesupportive role of clinical supervision can be very important.Therefore, we believe that the principles, techniques and tools contained in this guide can be applied to all oralhealth professionals throughout their careers. We hope that this guide will challenge even more experiencedsupervisors to review and enhance their supervisory practices.FIRST EDITIONHETI The Superguide9

The SupersummaryThe SupersummaryUnderstanding clinical supervisionDefinition of clinical supervision on page 14Three functions of clinical supervision:Educational role: Explained on page 16 with furtherexplanation and suggestions in part 3.Supportive role: Explained on page 16 with furtherexplanation and suggestions in part 4.Administrative role: Explained on page 16 with furtherexplanation and suggestions in part 5.Methods of clinical supervision on pages 20-22The supervisor’s toolkit (Part 6)Look here for activities, handouts and templatesto help you deliver effective supervision, frompage 77Getting started in clinical supervisionEstablisihing the supervisory relationshippage 79Getting to know your supervisee’s skill level page 80Setting up a supervision contract page 81Supervision contract template page 113Clinical supervision agreement template pages115-116Agenda template page 129Some core supervisory activitiesReflective practice pages 28, 91-93, 127Getting to know your supervisee’s skill level page 80Hands on/Hands off page 85Developing communication skills pages 88-90,104-105Providing feedback pages 94-97,Setting SMART goals pages 98-99, 107, 123Checklists and tipsChecklist for effective clinical supervision page 30Top ten tips for the teaching supervisor page 37Effective clinical teaching page 43Tips for developing clinical skills page 45Tips for formal teaching page 52Tips to foster engagement of the supervisee page 57Checklist for orientation of a new staff memberpage 73The tricky stuffGovernance page 19Common challenges for supervisors pages 58-59Managing a supervisee in difficulty pages 61-62Having a ‘crucial conversation’ pages 63-67Performance development and review page 74Risk management page 8710 HETI The Superguide FIRST EDITION

Throughout this guide, you will find several highlighted boxes each of which serves a different purpose.The SupersummaryVoices from the fieldThese are included to reflect the experiences and views of realsupervisors and supervisees in oral health throughout NSW.You will find ‘Voices from the field’ on pages 14, 15, 17, 23,26, 27, 29, 35,36, 44, 86Voices fromthe fieldI love to see the development of mysupervisees as they travel through their clinicaljourney.I enjoy watching them develop theirclinical skills and progress to a stage wherethey are self-suffi cient and practise witha lot more confi dence.Beyond the basicsSupervisors of oral health practitioners will be at different levelsin their development of their supervisory skills. For the moreexperienced supervisors, or those who want to extend their knowledgeand skills in clinical supervision, we have included ‘Beyond the basics’to provide suggestions for further reading, thinking, and enquiry in keyareas of supervision.You will find ‘Beyond the basics’ on pages 17, 18, 22, 23,27, 38, 41, 51, 53, 73, 78, 89, 102Beyond the basicsClinical supervision has a long history in thedevelopment of health professionals. Earlymodels of clinical supervision had their basis inthe “master and apprentice” model of learningbut clinical supervision has evolved since thenand is practised differently across differentprofessional groups.For a comprehensiveinterdisciplinary overview ofclinical supervision see Bernard,J. M., & Goodyear, R. K. (2013).Fundamentals of clinical supervision(5th ed.). Boston, MA: PearsonEducation.Reflective practiceTo be an effective clinical supervisor, it is important that you continuallyreflect on your own practice and development needs. The reflectivepractice boxes offer prompts for this.Reflective practiceWhat strengths do I bring to the role of supervisor?What skills do I need to develop to be more effective?You will find ‘Reflective practice’ prompts on pages 28, 35, 39,40, 89, 95What steps am I going to undertake to make sure that Idevelop these necessary skills?Case studiesCase studies are used throughout to highlight supervisory skillsin practice.You will find case studies on pages 46, 49, 66-67, 85, 90,92-93, 96-97Teaching a diagnostic skillThe supervisor has a discussion with ajunior clinician/student about the questionsused to diagnose a patient who attendswith pain. A problem-based learningprocess is introduced to the discussionalong the following lines: What are thediagnostic clues you looking for in theanswers you get from a patient when askingthe following questions?• Does it hurt when you eat or bite on thetooth?• Do you feel pain with sweet, hot or cold?• When you feel pain with hot or cold howlong does it last?FIRST EDITIONHETI The Superguide11

12 HETI The Superguide FIRST EDITION

part oneWhat is clinicalsupervision?What is clinical supervision?“The heart of supervision is learning – the learning of the supervisee.”Carroll, M. (2010). Supervision: Critical Reflection for Transformational Learning (Part 2).The Clinical Supervisor, 29(1), p. 1.

What is clinical supervision?What is clinical supervision?There are many ways to define clinical supervision. For the purpose of this guide, we define clinical supervisionas “The provision of guidance and feedback on matters of personal, professional and educational development inthe context of (the) experience of providing safe and appropriate patient care.” 1In oral health, most formal clinical supervision is governed by regulations and occurs during the training periodfor students and for new or returning practitioners. However, informal clinical supervision is also important and canbe part of the ongoing development of the clinical practitioner.Why clinical supervision?Clinical supervision is considered a vital part of modern,effective health care systems. 2Providing effective clinical supervisory support to healthprofessionals enhances patient outcomes and positivelyaffects trainee development, while inadequate supervisionhas been linked to poorer patient outcomes and lowerstandards of care. 3The Special Commission of Inquiry into the NSW AcutePublic Health System highlighted the link between patientsafety and the availability of supervision for junior clinicalstaff. 4Supervision of clinicians has been identified as a nationalpriority by Health Workforce Australia (HWA) as evidencedthrough the development of a National Clinical SupervisionSupport Framework and the Clinical Supervision SupportProgram. 5Voices fromthe fieldI remember one time early on when I hadto administer anaesthetic to a very anxious12 year old boy. I think I was even morenervous than the patient! I knew my handswere visibly shaking and I was really worriedabout what my supervisor would think.I needn’t have worried though.She calmly talked me through the procedureand debriefed it afterwards. She told methat lots of new therapists get nervous at firstbut the nerves soon settle down.That’s how it turned out for me.I think that the way a supervisor handlesthat sort of situation can really make or breakyou. Luckily my supervisor helpedbuild my confidence and skills.That’s the sort of supervisor I want to be!1 Kilminster, S., Cottrell, D., Grant, J. & Jolly, B. (2007). AMEE Guide No. 27: Effective educational and clinical supervision, Medical Teacher, 29 (1), 2-19.2 Milne, D. (2007). An empirical definition of clinical supervision, British Journal of Clinical Psychology, 46, 437-447.3 Kilminster, Cottrell, Grant & Jolly, above n 1.4 Garling, P. (2008). Final report of the special commission of inquiry: Acute care in NSW public hospitals, State of NSW, 27 November 2008.5 Health Workforce Australia (HWA) 2011a, National Clinical Supervision Support Framework – Consultation Draft, April 2011; Health Workforce Australia(HWA) 2011b, Clinical Supervision Support Program – Directions Paper, April 2011.14 HETI The Superguide FIRST EDITION

Clinical supervision facilitates:• delivery of high quality patient care and treatmentthrough accountable decision making and clinicalpractice;Voices fromthe fieldWhat is clinical supervision?• acquisition of skills and knowledge;• learning and professional development;• staff wellbeing, by provision of support;• reflective practice;• confidence and competence in clinical practice;• development of professionalism (a professionalidentity and ethical practice);• professional growth and development.Contributing to the professional development of oralhealth professionals can be one of the most rewardingparts of a senior clinician’s job.The importance of active clinical supervision cannot beunderestimated, yet many supervisors feel that they donot always have the time or the skills to provide it.This guide is focused on highlighting the importanceof effective clinical supervision and making it easier foryou to improve your supervisory skills.When I first started supervising, I really struggledto balance my supervisory duties with the needto keep up with my own clinical workload.I remember one day feeling really frustratedthat my supervisee was taking too long to completea task. I was tempted to take over and do it myselfbecause I knew I could do it a lot quicker.However, I remembered what it was likewhen I was starting out. I took a deep breathand let her finish what she was doing.She actually did a really good job!Later in her very successful career, I was fortunateto be present for a talk she gave in which shementioned the importance of the support andpatience I showed her in the early stages.I am so proud that I was able to make sucha positive impact through my role as a supervisor.Voices fromthe fieldAs a student only part way down the road ofbecoming an oral health therapist, I have alreadyrealised the value of an approachable supervisor –someone you are able to admit a mistake to and beconfident that they will help you get back on trackrather than just criticise or demean you.FIRST EDITIONHETI The Superguide15

What is clinical supervision?Functions of clinical supervisionClinical supervision comprises a number of different functions which many theorists have attempted to defineand explain. For the purposes of clarity and simplicity, this guide uses Kadushin’s 1 model of clinical supervision.Kadushin outlined three core supervisory functions: educational, supportive and administrative.While this guide has been organised around these three core functions, it should be noted that in practice, they donot stand alone but can be seen as overlapping and flexible.FunctionsEducationalSupportiveAdministrativeEducational development of each supervisee in a manner that enhances their full potential.• Providing knowledge and skills• Developing self-awareness• Reflecting on practice• Integrating theory into practice• Facilitating professional reasoningThe maintenance of harmonious working relationships with a focus on moraleand job satisfaction.• Dealing with job-related stress• Sustaining morale• Developing of a sense of professional self-worth.The promotion and maintenance of good standards of work, including ethical practice,accountability measures and adhering to policies of administration.• Clarification of roles and responsibilities• Work load management• Review and assessment of work• Addressing organisation and practice issues.Adapted from Northern Sydney and Central Coast Area Health Service, Social Work Supervision and Consultation Guideline, November 2009, p. 4.1 Kadushin, A. (1985). Supervision in Social Work (2nd ed.), Columbia University Press, New York.16 HETI The Superguide FIRST EDITION

Voices fromthe fieldFor me, clinical supervisionhas always been a two-way street.Over my years of experienceas a clinical supervisor, I think I’ve learnedas much from the people I’ve supervisedas they’ve learned from me.In the process of teaching, I pick up pearlsof wisdom from my superviseeswhich allows me to continually improveand reflect on my own clinical practice.Beyond the basicsClinical supervision has a long history in thedevelopment of health professionals. Earlymodels of clinical supervision had their basis inthe “master and apprentice” model of learningbut clinical supervision has evolved since thenand is practised differently across differentprofessional groups.For a comprehensiveinterdisciplinary overview ofclinical supervision, see Bernard,J. M., & Goodyear, R. K. (2013).Fundamentals of clinical supervision(5th ed.). Boston, MA: PearsonEducation.What is clinical supervision?The following references alsoprovide views on the supervisoryfunctions:Driscoll, J. (2007). Practicing clinicalsupervision: a reflective approachfor healthcare professionals.Elsevier, Philadelphia.Proctor, B. (1991). ‘Supervision:A co-operative exercise inaccountability’ in Marken,M & Payne, M (eds) Enabling andEnsuring. Supervision in practice.National Youth Bureau, Leicester.FIRST EDITIONHETI The Superguide17

What is clinical supervision?Who provides clinical supervision?How and by whom clinical supervision is provided is influenced by service delivery needs and by the contextin which the clinician is working (e.g. NSW Health vs private practice; urban, regional or rural).Clinical supervision can be provided by senior clinicians, team leaders and external supervisors.Deciding who provides clinical supervision depends on the context including the clinical setting, awardrequirements, and the availability and skill mix of staff.There is a diversity of organisational structures which will impact on the manner in which clinical supervisionis provided to an individual. There is no single method of clinical supervision which would adequately cover thediverse nature of these structures.For example a supervisee may:1. receive clinical supervision and be operationally managed by the same individual of the same discipline;2. report to an operational manager/unit head of the same discipline and have a different clinical supervisorfrom the same discipline within the same unit;3. report to a team leader from a different discipline for operational management and receive clinical supervisionfrom another person of the same discipline from outside their team.These are only three of many possible examples of supervisory relationships.It is acknowledged that senior clinical specialists may find it difficult to access suitably experienced clinicalsupervisors. However, they may still benefit from exploring options for peer supervision such as web-basedcommunication, networking at conferences, journal clubs, and formal peer supervision sessions.Beyond the basicsIf your experience of clinical supervision has been limitedto the idea that it is for new practitioners or those who are re-training,why not take the time to think about how clinical supervisionmight be beneficial as an ongoing part of professional developmentand good practice?Try asking practitioners from other areasof clinical practice (e.g. the mental healthfield) how they practise and utilise clinicalsupervision.18 HETI The Superguide FIRST EDITION

Governance and clinicalsupervisionIn addition to structures and support within Local HealthDistricts, there are a number of organisations involvedin the governance of oral health practitioners in NSWand in providing guidance for clinical supervision.The Australian Health Practitioner Regulation Agency(AHPRA) and the Dental Board of Australia (DBA)share responsibility for the governance of Oral Healthpractitioners across Australia.The New South Wales Registration Committee supportsthe DBA at a state level.The DBA has produced guidelines for supervision ofdental practitioners who:Complaint or concern about a clinicianGuidelines for managing complaints and concernsabout oral health practitioners in NSW can be foundon the NSW Health website.Complaint or Concern about a Clinician – Principlesfor Action – describes the principles for managingcomplaints or concern regarding all clinicians andoutlines the roles and responsibilities for ensuring allcomplaints or concerns are managed.Available here.Complaint or Concern about a Clinician – ManagementGuidelines – sets out an operational frameworkfor the use of public health organisations when dealingwith a complaint or concern about an individual clinician.Available here.What is clinical supervision?• are returning to practice after an absence,in accordance with the Dental Board’s recencyof practice registration standard;• have a condition on their registration or who haveentered into an undertaking that requires supervision;• make a significant change to a different field or scopeof practice;• hold a type of limited registration where supervisionis a requirement of registration.These guidelines and templates for supervision plansand reports are available here.This Oral Health Superguide does not replacemandated supervisory guidelines.The NSW Health Policy Directive for Practice Oversightof Dental Therapists, Dental Hygienists & Oral HealthTherapists in NSW is a useful reference for specificguidelines relating to these oral health practitioners.This document includes tools and forms to assessand review performance across core areas of clinicalpractice and additional areas of competency.It can be found here.FIRST EDITIONHETI The Superguide19

What is clinical supervision?Methods of clinical supervisionClinical supervision may occur in the following ways:• On a day-to-day basis• Structured one-to-one sessions• Peer-to-peer• In a group environmentFor clinical supervision to be effective, it is recommended that day-to-day supervision is supplemented withone-to-one structured supervision sessions at a frequency relative to the supervised professional’s experiencein the clinical area and length of practice.In addition to local policy, the frequency and duration of clinical supervision should be guided by requirements ofregistration bodies and/or professional associations.The following is adapted from South Eastern Sydney and Illawarra Area Health Service, Department of Nutrition andDietetics, Central Hospital Network, Clinical Supervision Program and Procedures, 2011, p.5.Day-to-day supervisionDay-to-day supervision is conducted where the supervisee has access to their supervisor in “real time” to facilitatethe delivery of patient care. Also known as “informal” supervision, it can occur face-to-face, over the phone or evenremotely via email. In addition, the supervisor may provide physical or “hands on” assistance if required to buildsupervisee confidence and to support the delivery of safe patient care.One-to-one structured supervisionOne-to-one structured supervision is conducted regularly, as determined by local supervision policies, professionalpractice requirements and/or agreement between the parties.The supervision session time should be protected and prioritised by both the supervisee and the supervisor.Supervision should be conducted in an appropriate environment that facilitates patient care/case discussion,reflective practice, and the setting and monitoring of learning goals and objectives.In the case of rural or sole/isolated supervisees, one-to-one supervision may be done by telephone,videoconference or online.One-to-one structured supervision benefits from proper planning and organisation.20 HETI The Superguide FIRST EDITION

Peer supervisionPeer supervision is usually conducted between twoor more experienced oral health professionals as amethod of consultation, problem solving, reflectivepractice and clinical decision making. It providesa forum for sharing of knowledge and experienceand is used to complement more formal avenues ofsupervision.Group supervisionThe purpose of group supervision is to provide aforum for facilitated open discussion and learningfrom each other’s experiences. This may include clinicalcase discussions, topics of interest, interprofessionalcollaboration and team work.(For more information on interprofessional collaboration,see page 101.)What is clinical supervision?• Peer supervision is much more a self-directedactivity and involves two or more oral health staffmeeting to supervise each other’s work.• It requires a strong motivation and commitmentfrom all participants to drive the process. Theresponsibility for the group, its wellbeing andensuring it meets its purpose is shared by allparticipants.• Whilst peer supervision is often considered a less“formal” process, it still requires a clear purposeand structure. Contracts and/or agreements areimportant and should address goals, expectationsof participants, how the process will work and any“ground rules”.• Groups may include those who have hadsupervision training, but members share theresponsibility for convening and facilitating sessions,often taking turns in being the supervisor andsupervisee.• It works well with staff of similar training andexperience that share values but hold a rangeof experiences.• It can be a valuable adjunct to formal supervision.It is also a consideration when addressing the needsof experienced clinicians or clinicians in rural settings.• It can involve a mix of case discussions, theoreticaldiscussions, role plays or case-based learning.• It is important that there is clarity about how feedbackwill be given to individuals in the group and thata culture of learning and self-reflection is fosteredamong participants.• Like all clinical supervision, peer supervisionrequires regular review to ensure it is meetingparticipants’ needs.Group supervision is led by a clinical supervisorand can be conducted face-to-face or using telehealthand online technology, particularly for rural, remote orsole practising clinicians.• Many of the principles of one-to-one supervision arejust as applicable in the group supervision context.• Group supervision is led by an appointed supervisor.However, individuals can gain from the reflection,feedback, sharing and input from colleagues as wellas the supervisor.• Like all supervisors, group supervisors require specificknowledge and skills, in particular about managinggroup processes.• Do some planning prior to establishing a supervisiongroup to ensure it is the most appropriate/feasibleform of supervision and will meet the needs of the oralhealth clinicians requiring supervision.• Carefully consider the composition of thegroup and selection of participants. Importantconsiderations include how many supervisees arein the group, as well as their skills, experience andindividual attributes.• Developing a clear supervision contract that isagreed to and signed by all is essential. Thisincludes the frequency of meetings, participants,model of supervision, role of the supervisor,expectations of the supervisee, review andevaluation processes and confidentiality.FIRST EDITIONHETI The Superguide21

What is clinical supervision?• It is important that there is clarity about how feedbackwill be given to individuals in the group and thata culture of learning and self-reflection is fosteredamongst participants.• Group dynamics do occur in group supervision andneed to be managed.• Ongoing monitoring is necessary to ensure that grouptime is managed equitably and the needs of eachparticipant are met.Beyond the basicsWhile group supervision may not be commonpractice in oral health, it is often used in otherhealth professions.Why not explore opportunities for settingup regular group supervision sessions withothers from the same professional group orfor interprofessional development?Consider the following:• What aspects of your clinical practice couldbenefit from group discussion and sharingof ideas and resources?• What issues and dilemmas do you think youshare with other professional groups?How could you find out?• What obstacles might get in the wayof establishing group supervision andhow could you overcome them?Here are some references to getyou started on understanding andfacilitating group supervision:Edmunds, S., & Brown, G. (2010).Effective small group learning: AMEEGuide No. 48. Medical Teacher, 32(9),715-726.Fleming, L. M., Glass, J. A., Fujisaki,S., & Toner, S. L. (2010).Group process and learning:A grounded theory model of groupsupervision. Training and Education inProfessional Psychology, 4(3), 194-203.Tulinius, C.-H. B. (2010).Continuing professional developmentfor general practitioners: supportingthe development of professionalism.Medical Education, 44(4), 412-420.22 HETI The Superguide FIRST EDITION

Supervision in rural andremote settingsIt is recognised that clinicians working in ruraland remote settings experience unique challenges inboth obtaining and providing supervision.Some of the common issues experienced by ruralclinicians include, but are not limited to:• the line manager is often also the supervisor henceit can be challenging to move between the two roles;• line management of clinicians is often outside thespecific discipline;• working in small department/teams and/or hospitalsmeans there are fewer staff members availableto provide supervision and or/supervisors canexperience burnout;Beyond the basicsA sole dental clinician is line managed by theirlocal operational manager who is from anotherhealth discipline. The nearest senior/experienceddental clinician is 200km away. Whilst theoperational manager provides day-to-day support,the dental clinician requires clinical supervisionexternal to the service to facilitate ongoingdevelopment and provide a forum for reflectivediscussion. The dentist discusses the needfor external clinical supervision with theoperational manager.What suggestions do you have for solvingthis problem?What is clinical supervision?• working in isolation as a sole clinician means thereis reliance on the individual to be proactive in seekingsupport remotely;• rural clinicians often work across a range of clinicalsettings which adds an additional level of complexityto the delivery of services and the educational needsof the clinician.Obtaining the required level of support may require“thinking outside the box” to harness resourcesand to obtain support from networks of peers or evenstaff located within other Local Health Districts orprivate practices.Voices fromthe fieldTips for rural and remote clinicians• Encourage supervisees to seek support and helpfrom other clinicians:– within the local area– outside the local area (includingmetropolitan centres)– from professional bodies.• Network with other clinicians within and outside theLocal Health District in both rural and metropolitanareas via email, phone and social media.• Join or create a peer support network or journal clubto share experiences and learn from each other.Providing good supervisionis particularly important in rural and remoteareas where we want to attract more staff.I find that investing my time in supervisionis really rewarded when we get studentswho want to work here and staff who stay.FIRST EDITIONHETI The Superguide23

What is clinical supervision?24 HETI The Superguide FIRST EDITION

part twoEffective clinicalsupervisionEffective clinical supervision“The quality of clinical supervision is the key influenceon the quality of the clinical placement and, ultimately, on the calibreof the health practitioner.”Health Workforce Australia (2011). National Clinical Supervision Support Framework,Health Workforce Australia: Adelaide.

Effective clinical supervisionSkills of an effective supervisorWhile many oral health supervisors need to juggle patient care and workplace demands with the supervisory role,even small changes in how they organise their clinical duties can make big differences to the effectivenessof supervision.Time spent actively supervising oral health professionalsis rewarded in two ways. The first is that active supervisionimproves supervisee performance, which saves time andenhances patient care. The second is that supervisorswho increase their involvement with staff tend to reporthigher levels of job satisfaction as playing a leading rolein the development of oral health professionals is personallyrewarding. It builds better team interactions and contributesto self-esteem for all involved.In order to provide high quality supervision, there are anumber of skills which supervisors should ensure theyactively focus on developing.Supervisory skillsVoices fromthe fieldAs someone just starting out inthis profession, I have really appreciatedthe value of a good supervisor.Being given support and guidance,particularly when I was a bit out of my depth,meant that I could constantly improveand learn and not just keepmaking the same mistakes!Being available: This is the big one! Supervisees appreciate receiving advice from their supervisor when theyencounter clinical situations beyond their current ability.Being aware: Supervisors should know what level of supervision is necessary for safe practice.They need to anticipate red flags and should be ready to respond if necessary.Being organised: To make the most of the limited time available, it is important for a supervisor to be organised.This includes prioritising time for structured supervision sessions.Personal skillsEmpathy: Do you remember what it was like to be a more junior clinician? A good supervisor uses insight andunderstanding to support supervisees.Respect: Showing respect for supervisees and others promotes positive working relationships. This should occurregardless of individual differences and levels of experience.Clarity of expectations: A common problem for supervisees is uncertainty about what their supervisor thinksor wants. Clear expectations and honest feedback from supervisors is highly valued.Confidentiality: Supervisees are more open and honest about errors or lack of capability if they can discuss thesematters in confidence with their supervisor.26 HETI The Superguide FIRST EDITION

Voices fromthe fieldWhen we take on new graduates,I stay with them in the clinic for the firstthree months. We have high decay rates hereso they are confronted with a lotof difficult clinical situations.They find it reassuring to know I’m therein the background to help them.This initial supervision also allows usto mould them to practise withinour clinical guidelines.I believe effective clinical supervision atthis early stage of a clinician’s career createsfar better clinicians in the long run.Teaching skills: In order to be an effective teacherit is important to invest in your own professionaldevelopment to enhance teaching skills.For more information on teaching refer to Part threeof this document.Professional skillsModelling: A good supervisor models professionalismand ethical practice. New supervisees in particular willbe watching you to decide how to conduct themselvesin the workplace. They need to work out how whatthey have learned to date translates into the everydayworking world.If you cut corners, dismiss rules, or engagein unprofessional conduct, you are teaching yoursupervisee that this is OK. If you model exemplaryprofessional conduct you will be playing a rolein developing good clinicians for the future.Effective clinical supervisionA motivating and positive attitude: Most peoplerespond best to encouragement, and feedback is moreeffective if framed in constructive terms.Ability to reflect on practice: A supervisor who is ableto reflect on their own practice provides a valuable rolemodel for supervisees.Willingness to allow supervisees to grow, beindependent and make some mistakes without fearof blame: While the aim of supervision is to minimiserisk to patients and build confident and competentprofessionals, everyone makes mistakes. All supervisorswere junior clinicians once and should acknowledgethat some of the most important lessons learned werefrom making mistakes and putting plans into action toprevent them from happening again.Clinical skills: The modelling of good clinical skills is oneof the most effective ways that supervisors help theirsupervisees. The clinical skills of supervisors should beup-to-date and evidence-based.Up-to-date: Part of professional conduct is keepingup to date on regulations and professional requirements.Do you know where to find the code of conduct for yourprofessional group?Beyond the basicsIf you aren’t sure, find the regulations or guidelinesgoverning the provision of supervision for yourprofessional group and locate and review yourprofessional code of conduct.FIRST EDITIONHETI The Superguide27

Effective clinical supervisionReflective practiceEffective supervisors engage in reflective practice throughout their careers. This is the ability to critically reflecton one’s own practice. It includes identifying strengths and weaknesses, determining actions required to improveskills, and developing clinical reasoning skills to ensure the delivery of safe patient care.Reflective practice is an effective process to develop self-awareness and facilitate changesin professional behaviour.“Reflection is a metacognitive process that occurs before, during and after situations with the purpose of developinggreater understanding of both the self and the situation so that future encounters with the situation are informedfrom previous encounters.” 1Repeated exposure to the complexities of clinical work leads experienced clinicians to develop “mental models”of clinical experiences that can be drawn upon to facilitate quick decisions in response to varied and complexclinical situations. 2 Reflective practice allows the clinician a clearer conceptualisation of these processes and canguide self-directed learning when gaps in knowledge or skills are identified.Effective supervisors also encourage their supervisees to engage in regular reflective practice.A model of reflective practice which can be used in supervision is described in more detail on pages 91-93of this document.To encourage supervisors to practise what they (should) preach we have included prompts throughout this guidefor the supervisor to reflect on their own practice and to help identify areas for continuous improvement.An example is below.Reflective practiceWhat strengths do I bring to the role of supervisor?What skills do I need to develop to be more effective?What steps am I going to undertake to make sure that I develop these necessary skills?1 Sandars, J. (2009). The use of reflection in medical education: AMEE guide no. 44, Medical Teacher, 31, 685-695.2 Ibid, pp 687-688.28 HETI The Superguide FIRST EDITION

Barriers to effectivesupervisionIt is important to identify the components which do notcontribute to high quality supervision and address thesewhere possible.Being absent or unavailable: Limited or no supervisionand/or a lack of access to a supervisor is ineffective andcreates anxiety amongst supervisees. It also has a directimpact on the quality and safety of patient care.Being rigid: Setting rules without giving reasons orgiving instructions without an explanation does notcontribute to a positive supervisory relationship.This is not to say that supervisors have to explaineverything all the time but there has to be time forexplanations.Voices fromthe fieldBeing an effective clinical supervisoris more than being a competent clinicianwith good clinical skills,it’s the whole package.Sometimes we need to acknowledgewhen we are not the right fit for a superviseeand refer them on to someone else.Effective clinical supervisionIntolerance and irritability: This leads superviseesto avoidance (e.g. hiding errors and gaps in theircapability).Telling instead of coaching: This can lead tosupervisees feeling unsupported and unable to developtheir skills within the context of their learning stylesand education needs.Having a negative attitude or “blaming”:Publicly criticising the supervisee’s performanceor seeking to humiliate the supervisee leadsto adverse relationships.Not managing supervisees in difficulty:There are many reasons for sub-optimal performance,including poor orientation or poor supervision.Not supporting a supervisee in difficulty has a directimpact on the quality of patient care delivery.FIRST EDITIONHETI The Superguide29

Effective clinical supervisionChecklist for effective clinical supervision:55Develop a supervision contract that clearly defines the roles and responsibilitiesof the supervisory relationship.55Maintain confidentiality within the limits of the supervision contract.55Keep the supervisee safe and well by actively monitoring his/her level of stress and ability to cope.55Acknowledge the current skills and experience of the supervisee.55Address the individual needs of the supervisee, including learning preferences.55Acknowledge the supervisee as a person.55Provide positive reinforcement when new skills and knowledge are acquired to reinforce learning.55Ensure feedback is provided in a positive way and addresses areas of further development clearlyand unambiguously.55Acknowledge and manage factors that may influence the relationship (e.g. seniority, gender, culture).55Provide a supportive, professional but friendly environment, free from any intimidation.55Conduct supervision in the context of building a clinical team in which all members are accordedprofessional respect.30 HETI The Superguide FIRST EDITION

Responsibilities of the superviseeWhile it is the responsibility of the clinical supervisor to remain active in overseeing clinical care, supervisees mustalso be encouraged to engage and commit to the supervisory process.Effective clinical supervisionSupervision is one of the most important relationships of an oral health professional’s career. This can be facilitatedby actively encouraging the supervisee to seek assistance when required and identify appropriate learningopportunities.To get the most out of supervision, superviseesshould:• take responsibility for self-directed, lifelonglearning including a commitment to ongoingprofessional development;• actively participate in the supervision process;• openly express needs and expectations relatedto supervision and ensure these form the basisof the supervision contract;• make the best use of supervision by coming prepared,including having an agenda of points to be discussedso time can be used effectively;• make an effort to create and protect timefor supervision, keep scheduled supervisionappointments, be on time and try to avoidinterruptions;• be prepared to openly identify and discuss practiceissues which are challenging and the skillsthat need developing;• work at developing trust in the supervisory relationshipso that issues can be discussed honestly and freely.This makes supervision more meaningful and relevant;• contribute to reflective discussion about practiceexperiences and learnings;• be open to learning and improving clinical practiceskills and incorporating this learning into theirwork practice;• be prepared to be challenged in a supportive way;• be open to receiving support and feedback duringsupervision and take time to reflect and respondto this feedback;• take responsibility for seeking help when required,even if outside the regular supervision time.This ensures patient safety and wellbeing arealways put first;• commit to regularly reviewing the supervision processand give honest feedback if it needs to be adaptedto meet changing needs.FIRST EDITIONHETI The Superguide31

Effective clinical supervision32 HETI The Superguide FIRST EDITION

part threeThe educational role“Put simply, the education of health professionals in the 21st Centurymust focus less on memorising and transmitting facts and moreon promotion of the reasoning and communication skills that willenable the professional to be an effective partner, facilitator, adviserand advocate.”The educational roleFrenk, J, Chen, L, Bhutta, Z, Cohen, J, Crisp, N, Evans, T, Fineberg, H, Garcia, P, Ke, Y.Kelley, P, Kistnasamy, B, Meleis, A, Naylor, D, Pablos-Medez, A, Reddy, S, Scrimshaw, S,Sepulveda, J, Serwadda, D & Zurayk, H. (2010)., Health professionals for a new century:transforming education to strengthen health systems in an independent world,The Lancet, 376, 1923-1958.

The educational roleThe clinical supervisor’s educational roleThe clinical supervisor has an important educational rolewhich can include providing development opportunitiesfor any of the following:• Students• New graduates• Clinicians returning to practice after extended breaks• Clinicians moving from overseas• Those moving into new and unfamiliar areasof practice (for example a clinician who has previouslyonly worked with adults now working with children)• Introducing supervisees to new proceduresor techniquesClinical teaching aims to:• improve knowledge and skills;• integrate theory into practice;• develop self-awareness;• facilitate reflection on practice;• enhance clinical reasoning.In addition to clinical skills, the supervisorshould also teach the non-clinical skills neededto manage workload, interprofessional practice,team dynamics and the demands of the rapidlychanging health care environment.The purpose of the educational component ofsupervision is to develop each individual in a mannerthat enhances their full potential, ensures patientsafety, and helps develop effective and ethical practice.This may be complemented by the provision ofeducation in other teaching forums such as in-serviceeducation and case discussion.34 HETI The Superguide FIRST EDITION

Promoting a culture of lifelong learningThe educational roleSupervision provides an ideal forum to promote a culture of lifelong learning. Lifelong learning refers to thecontinuous building of skills and knowledge through experiences encountered over the course of a lifetime.It encompasses not only structured learning through education but also learning through personal experience.Lifelong learning is linked to the pursuit of personal or professional knowledge and is voluntary and self-directed.Linked to the concept of lifelong professional learning,discipline specific professional associations andprofessional registration boards have guidelines regardingspecific education requirements for their profession.This includes meeting continuing professional development(CPD) requirements and maintaining CPD portfolios.However, self-directed and lifelong learning is an attitudinalapproach which should be modelled by all senior oralhealth professionals over the course of their careers.Voices fromthe fieldI enjoy clinical supervisionand get a great sense of delight in being asignificant part of the students’learning experience.I am still quite new in myclinical supervision role so I constantly reflecton my actions to improve my skills.Reflective practiceWhat attitude do I bring to meeting my CPD requirements?Do I choose meaningful and relevant professional development opportunities to continually extend and updatemy professional body of knowledge and to enhance patient care, or do I just go for what is available andconvenient at the time?Do I need to make any changes to the way I engage in ongoing professional learning?FIRST EDITIONHETI The Superguide35

The educational roleFacilitating the learning processThere are several approaches to learning that can occur within the context of supervision.Most people learn through a combination of deductive (learning through structure) and inductive (learning byexperience) approaches.When facilitating learning, it is important to consider principles of adult learning, different learning preferencesand a mix of modalities.Principles of adult learning• Adult learners need to be respected, valued andacknowledged for their past experienceand have an opportunity to apply this experienceto their current learning.• Adults learn best in environments that reduce possiblethreats to self-concept and self-esteem and providesupport for change and development.• Adult learners are highly motivated to learn in areasrelevant to their current needs, often generated by real lifetasks and problems.• Adult learners need feedback to develop.• Adult learners have a tendency towards self-directedlearning and learn best when they can set their own pace.• Adults learn more effectively through experientialtechniques (eg, discussion and problem solving). 1,2Voices fromthe fieldI try very hard to remain calm and coolthroughout the most challengingof experiences and feel that this attitudehelps my supervisees to gain confidencein themselves. Even if a supervisee isstruggling with a procedure or a concept,I try to find a positive in their abilitieswhen providing feedback.I have found over the years that eventhe most nervous supervisee can gainconfidence and develop sound clinical skillswith effective teaching.1 Brundage, D. & Mackeracher, D. (1980). Adult learning principles and their application to planning, Toronto, Ministry of Education of Ontario.2 Brookfield, S.(1998). Understanding and facilitating adult learning: a comprehensive analysis of principles and effective practices. Open University Press,Buckingham.36 HETI The Superguide FIRST EDITION

Top ten tips for the teaching supervisorThe educational role1. Every little bit helps: Seize the teaching moment.Even if you don’t have the whole package workedout, it’s still worthwhile sharing what you can,as best you can. Don’t have time to run through aprocess or procedure in full? Draw the supervisee’sattention to one key aspect of the task.No time for a complete debrief immediately aftera difficult case? Ask a few key questions to checkthe supervisee’s understanding of what occurredand give quick feedback. Follow up later whenthere is time.2. Teach by guided questioning: Ask questionsto discover the state of the supervisee’s knowledgeand understanding. Encourage independent thinkingand problem-solving. Effective questioning uncoversmisunderstandings and reinforces and extendsexisting knowledge. Questions keep superviseesengaged, “on their toes”, listening and thinking.3. Invite supervisees to set the agenda: Adult learnersshould be involved in decisions about the directionand content of learning. Your ultimate objective asa supervisor is to foster the supervisee’s abilityfor self-directed lifelong learning.4. Encourage questions: Questions fromsupervisees should always be treated with respect.You may be shocked at what they did not know,but on closer inspection, may discover that othersare just keeping quiet. The three most importantwords in teaching and learning are “I don’t know”.5. Focus the learner: Start any teaching by settingup the importance of the session. Teaching ismore effective if it is tailored to learners’ interests,ambitions and current level of knowledge and ability.Answer the question: why should they pay attentionto what you are about to teach them?6. Focus the learning: Don’t try to teach too muchat once. Try not to repeat what is already known.Clinical situations are complex but limit the learningto the key aspects that form the learning edgeof your audience’s knowledge base. Proceduresand processes can be broken down into steps,not all of which have to be covered at once.7. Encourage independent learning: Don’t tryto teach everything – give enough information to setsupervisees on track, then ask them to complete thetask themselves. Set tasks that require superviseesto act on the information you have provided. Keeplearning open-ended. Encourage superviseesto seek other educational opportunities and reportback on their learning.8. Teach evidence-based practice: Build a lifelonglearning attitude in your supervisees.Even more important than knowing the currentbest answer to a clinical problem is having the skillsto identify a clinical question, search the clinicalliterature, appraise the evidence and form anevidence-based plan.9. Check the understanding of supervisees:Have supervisees actually understood what hasbeen taught? Can they demonstrate clinicalreasoning and put knowledge and skills intopractice? If not, perhaps revisit specific topicsor skill areas until supervisees feel confidentand can show that they have learned.10. Evaluate your own practice as a teacher:How well did your supervisee learn from theinformation you provided? Every time you teach youhave a chance to learn how to do it better (and moreeasily) next time. Try different methods and comparesupervisee outcomes. Seek feedback from yoursupervisees. Compare notes with your peers.FIRST EDITIONHETI The Superguide37

The educational roleBeyond the basicsFind out about the ‘Teaching on the Run’ program and bookdeveloped by the University of Western Australia’s Facultyof Medicine and Dentistry. It is based on a series of workshops aimedat practising clinicians who are responsible for supervising students.The program was originally designed for doctors involved in teachingand supervising trainees but has been developed into a programcalled ‘Teaching on the Run for Oral Health’ by Professor Fiona Lake,one of the creators of the ‘program, in collaboration with ClinicalEducation and Training Queensland (ClinEdQ).The articles that make up the original‘Teaching on the Run’ book can beviewed online at mja.com.au or meddent.uwa.edu.au38 HETI The Superguide FIRST EDITION

Developing skills in teaching and educationThe educational roleSkills in clinical education must be learned like everything else in clinical practice. Years of experience in clinicalpractice alone do not necessarily make you a good teacher of clinical skills.Clinical supervisors should be actively seekingto improve their knowledge and skillssurrounding:• principles of adult learning;• current evidence in clinical education;• delivering effective presentations;• benefits of blended learning;• providing constructive feedback;• facilitating reflective practice and clinical reasoning;• utilising broad based evidence to inform practice.Skills and knowledge can be obtained throughblended learning methods including:• self-directed learning;• sharing of information and resources;• review of literature in a group formatsuch as a journal club;• online learning packages;• participation in simulated learning environments;• attending face-to-face courses in clinical supervisionand education.Reflective practiceWhat teaching skills do I bring to my educational role in clinical supervision?How familiar am I with principles of adult learning and effective teaching?How can I ensure that I continually improve in my educational role and keep focused on the learner’s needs ratherthan what I want to say?FIRST EDITIONHETI The Superguide39

The educational roleLearning stylesIt is useful for anyone in an educational role to give some thought to varying their teaching strategiesto accommodate different modes of learning.There is a difference of opinion amongst theorists about the value of identifying learning styles and targetingteaching to preferred learning styles. A model of one view of learning styles is given on page 42 for you to reviewand consider.A useful way of thinking about the different approaches to learning is that the way we learn varies from individualto individual and from task to task. For example, some people are likely to be better than others at learninginformation through observation and reflection, while others may be better at learning information through activeinvolvement. The same individual may prefer different modes of learning across different learning tasks.Another point to consider is that the practicalities of workplace learning mean that some information needsto be learned via a certain mode. For example, it would be difficult to become skilled in taking x-rays just by havingthe method explained verbally. Most people need to learn practical tasks by observing a demonstration of the taskand then doing it themselves, regardless of their preferred learning style.People generally prefer variety when learning. Even if a learner prefers to have information presented verbally,they are likely to reach a point of overload if the only mode of teaching is lecture style!Reflective practiceConsider your own past learning experiences. What learning opportunities or methods of deliveryhave you found most valuable?What generally doesn’t work for you?How can you use your own experiences as a learner to inform and improve your teaching practicesas a clinical supervisor?40 HETI The Superguide FIRST EDITION

Beyond the basicsThe educational roleIf you would like to know more about learningstyles, below are some references to getyou started. You might like to draw your ownconclusions by considering both sides of theargument about the usefulness or otherwiseof adapting learning opportunities to identifiedlearning styles or preferences.Cassidy, S. (2004). Learning styles:An overview of theories, models,and measures. EducationalPsychology, 24 (4),419-444Jessee, S. , O’Neill, P. & Dosch, R.(2 006). Matching student personalitytypes and learning preferences toteaching methodologies . Journalof Dental Education, 70 (6 ) 644-651.Murphy, R. J., Gray, S. A., Straja,S. R., & Bogert, M. C. (2004).Student learning preferences andteaching implications. Journal OfDental Education, 68(8), 859-866Riener, C. & Willingham, D. (2010).The Myth of Learning Styles.Change, 42(5), 32-35.FIRST EDITIONHETI The Superguide41

The educational roleIdentifying different learning stylesMany models exist which describe different learning styles. 3 , 4 Learning styles may be determined throughadministering learning style questionnaires (eg, Myers-Briggs Type Indicator) 5 or discussing with the superviseehow they learn best (e.g. preferred learning style, environment and methods). One example of a learning style modelis described below.A learning style modelActiveexperimentationPutting their theoryinto practiceActivistsProcessingPragmatistsConcreteexperienceHaving anexperiencePerception continuumAbstractconceptualisationDrawing theirown conclusionsReflectorscontinuumTheoristsSource: Honey P, Mumford A (2000). The learning styles helper’s guide.http://www.nwlink.com/~donclark/hrd/styles/honey_mumford.htmlReflectiveobservationReflecting onexperienceReflector: Prefers to learnfrom activities that allow themto watch, think, and review whathas happened (time to think thingsover). Likes to use journals andbrainstorming. Lectures are helpfulif they provide expert explanationsand analysis.Theorist: Prefers to think problemsthrough in a step-by-step manner.Likes lectures, analogies, systems,case studies, models and readings.Talking with experts is normallynot helpful.Pragmatist: Prefers to apply newlearnings to actual practice to seeif they work. Likes laboratories,field work, and observations.Likes feedback, coaching,and obvious links between thetask-on-hand and a problem.Activist: Prefers the challengesof new experiences, involvementwith others, assimilations androle-playing.3 Kolb, D. (1999). The Kolb learning style inventory, Version 3, Hay Group, Boston.4 Honey, P. & Mumford, A. (2000)., The learning styles helper’s guide, Maidenhead, Peter Honey Publications Ltd, viewed on 4 April 2013,http://www.nwlink.com/~donclark/hrd/styles/honey_mumford.html5 Myers, I., McCaulley, M., Quenk, N. & Hammer A. (1998). MBTI Manual: A guide to the development and use of the Myers Briggs type indicator,Consulting Psychologists Press, 3rd edition.42 HETI The Superguide FIRST EDITION

What constitutes effective clinical teaching?The educational roleCollaboration and active involvement.Adults like to have input into their learning.Relevance to the clinical duties currentlyrequired of the supervisee, or to their futurecareer plans.Teach the individual: Ascertain what thesupervisee is interested in and then directyour teaching to this motivation. For example:a junior dentist has been limited to providingpatients routine general dental treatment butwishes to develop their skills in crown andbridge work.There may be opportunities to develop theirskills and confidence in this area by encouragingthem to take on more complex tasks as partof their clinical duties with the supervisor’songoing coaching and support.Appropriateness to the level of the supervisee.Teaching by guided questioning.Asking and encouraging thinking.Didactic teaching (lectures) is most effectivewhen you know the knowledge baseof your audience (ask first). A failure of somedidactic teaching is that time is spent teachingsupervisees things they already know.The advantage of guided questioning is thatit reveals what supervisees do know andinvites them to extend their knowledge. Butdon’t turn questioning into a grilling. Make suresupervisees are provided with space to thinkabout their responses and if they require moretime to process what is being taught, offerto continue the discussion later once they havehad a chance to reflect.Setting clear learning goals with the superviseeso expectations are clear. Document SMARTlearning goals: Specific, Measurable, Attainable,Relevant, and Timely. (See page 98 forinformation on setting SMART goals.)Giving feedback so that supervisees know howthey are going. (See page 94 for advice on givingfeedback.)Seeking feedback so that you know howeffective teaching has been.Simply telling people what you expect themto learn will focus their attention in a clinicalencounter.Feedback given and received lets everyoneknow whether the intended outcomes are beingachieved.Adult learning is a collaborative process.FIRST EDITIONHETI The Superguide43

The educational roleIdentifying opportunities for clinical teachingThere are many situations which occur on aday-to-day basis in a clinical setting which can beturned into opportunities for clinical teaching. Whileit is beneficial to allocate specific time for teaching(when required), using opportunities as they becomeapparent can be beneficial to supervisees.Some of the forums where teaching can occur include:• in the presence of patients;• during case discussion;• during treatment planning;• interdisciplinary (i.e. with other oral health disciplines);• interprofessionally (e.g. with medicine and allied health).Voices fromthe fieldI am a very patient person, so watchinga trainee attempt a procedure slowly doesnot concern me. I don’t mind if a traineetakes a while to complete the treatmentand I am prepared to demonstrate and tutorthe trainees as many times as required.However as a clinical supervisor I amaware that I may need to step in to speedthings up if the trainee is running overtimeor the patient has had enough treatmentfor that appointment. I know that it isa fine balance between allowing the traineeto improve their skills and taking overthe treatment.44 HETI The Superguide FIRST EDITION

Developing clinical skillsTips for developing clinical skillsThe educational roleSkills training can begin with virtual experience(e.g. texts, scripts, videos, online tutorials, simulations,role plays) but it has to be completed in the workplacewith real patients. Supervisors need to be ready toteach a skill when the opportunity arises.A four-step approach to teaching skills describedby Walker and Peyton 6 and adopted in Teaching onthe Run 7 is:1. Demonstration: Trainer demonstrates the skillat normal speed, without commentary.2. Deconstruction: Trainer demonstrates the skillwhile describing the steps required.3. Comprehension: Trainer demonstrates the skillwhile the supervisee describes steps required.4. Performance: The supervisee demonstrates theskill and describes steps while being observed bythe trainer.• Don’t forget fundamentals: hygiene and infectioncontrol, patient communication, consent,and introductions.• Demonstration: make sure the learner can clearlysee what you are doing. Demonstration by thesupervisor can be combined with performanceby the learner.• Integrate theory with practice: that is, not onlydemonstrating skills but explaining the logicand the evidence behind the practice. Thishelps to develop clinical reasoning.• Don’t teach everything at once: particularlyfor the demonstration of more complex skillsor procedures. Not every step needs to be taughtin every encounter. Begin by establishing whatthe supervisee already knows. Review theunknown steps in more detail.• Provide opportunities to practise skills: makingtime and space available for the superviseeto be hands-on, breaking procedures into steps,providing direction and sharing care. Repetitionis the key to skills training, with the focus ofteaching building on competency.• Use collaborative problem solving: givesupervisees a clinical problem and work withthem towards a solution.• Give feedback: that is timely, specific, andconstructive. Ensure feedback is given in anappropriate environment. Good providersof feedback also invite feedback from thesupervisee, with a view to improving theirteaching technique.• Provide appropriate learning resources: knowingwhat is available to help supervisees developa deeper level of understanding.6 Walker, M. & Peyton, J. (1998). Teaching in theatre, in Peyton JWR, editor, Teaching and learning in medical practice, Manticore Europe Ltd,Rickmansworth, UK, 171-180.7 Lake, F. & Ryan, G. (2006). Teaching on the run: teaching tips for clinicians, MJA Books, Sydney.FIRST EDITIONHETI The Superguide45

The educational roleCase studies: Developing clinical skillsTeaching a surgical skillA twenty nine-year-old patient is booked in for removal of a partially erupted third molar tooth.This is the first time the junior clinician is performing this surgical procedure. The senior clinician elicitsfrom the junior clinician the steps involved in the process and discusses the surgical flap design andthe plan to remove bone around the tooth to simplify its removal. Drawings have been usedin the discussion to clarify points for possible bone removal, sectioning of the tooth, good positionfor elevation of the tooth parts, and warnings about areas of risk to the patient during the procedure.The junior clinician learns the importance of simple surgical techniques, the risks to the patient,and is informed of conditions when the senior clinician may need to assist.The senior and junior clinicians together explain the process to the patient, discuss the risksassociated with the surgery, and complete the patient’s request /consent for the treatment.The surgical procedure is carried out and the junior clinician is guided through the processby the senior clinician.Outcome: The junior clinician has learned the simple aspects of the surgical procedure, has sharedand practised communication and the consent process with patients, and has satisfactorily completedthe surgical removal of a partially erupted third molar tooth.Teaching a diagnostic skillThe supervisor has a discussion with a junior clinician/student about the questions used to diagnosea patient who attends with pain. A problem-based learning process is introduced to the discussionalong the following lines: What are the diagnostic clues you looking for in the answers you get froma patient when asking the following questions:• Does it hurt when you eat or bite on the tooth?• Do you feel pain with sweet, hot or cold?• When you feel pain with hot or cold how long does it last?• Is there anything you can do to make the pain subside?• Does the pain wake you during the night?46 HETI The Superguide FIRST EDITION

SNAPPSSNAPPS is a learner-centred model developed byWolpaw et al. 8 which is used in medical education asa means of teaching supervisees how to present casesin supervision. The model requires that the supervisee’scase presentation includes a concise summary of thefacts followed by five steps that require the verbalisationof clinical thinking and reasoning.The SNAPPS format encourages the superviseeto reflect on the problem and possible solutions beforeasking you. It’s a good way to promote higher levelclinical reasoning skills.This model can be adapted to the oral health settingto encourage active cognitive processing on the partof the supervisee.Narrow the differentialThe supervisee offers no more than 3 possibilitiesto explain the patient’s presentation. The differentialmay focus on what the problem is, why the problemhas emerged, what interventions might be considered,or relevant preventive health strategies.Analyse the differentialThe supervisee employs comparing and contrastingto discuss the differential possibilities. The discussionprompts the supervisee to verbalise their thinkingprocesses and can stimulate an interactive discussionwith the supervisor. Reviewing the pros and consfor each differential allows the supervisee todemonstrate analytic clinical skills, regardless oftheir level of knowledge or experience.The educational roleTo introduce the model in supervision, you should firstteach the model to your supervisee and coach them init until they are familiar with the steps and proficient inits use.The components of the model are:S – summarise the history and findingsN – narrow the differentialA – analyse the differentialP – probe the supervisor by asking questions aboutuncertainties, difficulties, or alternative approachesP – plan management of the patient’s issuesS – select a case-related issue for self directed learningSummariseThe supervisee presents a concise summary of the case(usually no longer than 3 minutes), highlighting only therelevant facts.Probe the supervisorDuring this step, the supervisee is expected to revealareas of confusion and knowledge deficits by probingthe supervisor rather than waiting for the supervisorto ask the questions. The supervisee is taught to usethe supervisor as a knowledge resource that can bereadily accessed.Plan managementThe supervisee initiates a discussion of patientmanagement with suggestions for intervention.This is a good opportunity for the supervisor to providesome feedback.Select an issue for self-directed learningThe supervisee identifies gaps in their knowledgebase arising from the case presented and plans stepsto improve later performance, e.g. through independentreading.In this model, both supervisees and supervisors haveimportant roles in building an educational opportunitythat stimulates thinking and questioning.8 Wolpaw, T., Wolpaw, D., & Papp, K. (2003). SNAPPS: a learner-centered model for outpatient education, Academic Medicine, 78 (9), 893-898.FIRST EDITIONHETI The Superguide47

The educational roleTeaching in the presenceof patientsClinical teaching at the point of care is the place wheretheoretical knowledge is made practical in the realworld, with real patients.Supervisors can use opportunities to teach in thepresence of patients by identifying patients from theirown case load who would provide a beneficial learningopportunity to supervisees, or work with a patientfrom the supervisee’s caseload.In preparing to teach in the presence of patients, thefollowing principles should be applied to ensure patientcomfort:• If possible, provide advance notice to the patient.• Obtain consent in private wherever possible andbefore the teaching session.• Ensure introductions are made.• All procedures, discussions and communicationsshould be explained and made understandable to thepatient as the teaching occurs.• Thank the patient and invite questions.Note: Patient safety, comfort, privacy and confidentialityis paramount and should be monitored at all times.Tips for teaching in the presenceof patients• Start small, and stay within your comfort zone asa teacher.• Remember what is routine to you may be newto the supervisee.• Allocate sufficient time for point of care teaching.• Involve the supervisee. Negotiate the goals.Let them select the focus of teaching.• Orient the supervisee to your plans prior to thesession, including clarifying their role and whatyou hope they will learn from the experience.• Skills/procedures can be modelled first by thesupervisor and then demonstrated by superviseesor supervisees may perform all or part of theinterview, procedure or intervention.• Teaching by guided questioning is generallybetter than just telling, because it allows youto determine the supervisee’s level of knowledgeand understanding. Ask the supervisee to reportback to check understanding.• If the supervisee appears to be struggling or is offtrack, make a smooth transition to take over theclinical interaction.• Don’t criticise at the point of care, debriefelsewhere constructively.• Afterwards seek feedback from the supervisee.Reflect on the effectiveness of the session andprepare for the next one.48 HETI The Superguide FIRST EDITION

Case study: Teaching in the presenceof patientsThe educational roleA dentist is supervising a trainee who has accidentally cut the patient’s mouth during a procedure.The trainee is hiding the cut with her finger. The dentist asks the trainee to move her finger and some blood startsto flow from the cut.What next?Path oneThe dentist asks the trainee why she was hidingthe cut and berates her for being careless.The patient becomes upset and refuses to let thetrainee finish the procedure.The dentist steps in to take over.While completing the procedure, the dentist saysto the trainee “If you had done it like I taught you,this wouldn’t have happened. Not only have youbeen careless but I don’t like the fact that youtried to cover up your mistake.”The patient later makes a complaint about thetrainee’s lack of skills and professionalism.Path twoThe dentist calmly comments that there lookslike a small nick at the corner of the mouth likeyou sometimes get when shaving.The dentist applies a dressing to the wound,whilst reassuring the patient.The dentist debriefs the incident with the traineeafter the patient has left.The dentist uses prompting techniques to elicitfrom the trainee the appropriate course ofaction to take once becoming aware of thissort of problem and the issues that can arisefrom trying to cover up mistakes.The dentist and the trainee discuss appropriatemeans of communicating about a problemin front of a patient without creating undue alarm.Path one exemplifies the supervisor’s lack of consideration for the effect on both the patient and the trainee ofhearing the trainee’s skills and professionalism seriously questioned in the middle of a procedure. This approachis likely to create considerable anxiety in the patient and is also highly demoralising and demotivating for the trainee.It damages the supervisory relationship and would probably make it very difficult for the trainee to approach thesupervisor about any future problems.Path two outlines the supervisor’s ability to model an appropriate response to a common procedural mishap.The supervisor uses this as a teaching opportunity to highlight appropriate patient care, communication skills, andethical practice. In using prompting techniques, the dentist allows the trainee the opportunity to demonstrate whatshe has learned from the experience. By debriefing afterwards, the supervisor can build the relationship with thetrainee so that she is encouraged to disclose rather than try to hide any future errors.FIRST EDITIONHETI The Superguide49

The educational roleTeaching during casediscussionTeaching by guidedquestioningCase discussion may occur during the formalone-to-one supervision session or periodically duringday-to-day interactions and discussions regardingpatient care.Supervisors can use these discussions to provideadditional information or to impart skills and knowledgethat explain the need for specific interventions. It is alsoan opportunity to encourage reflective practice.Using guided questioning to find out why the superviseefeels a particular problem exists or should be solvedin a certain way further develops strong clinicalreasoning skills and confidence in clinical practice.See page 47 for a model to guide case discussion.Teaching by guided questioning encouragesindependent thinking and problem solving.It allows the supervisee to test options, analyse risk andconsider limitations and innovations.Examples of guided questions• What approach are you taking in this situationand why?• Can you explain the steps of the task/treatment/intervention and why they are completed in this way?• What outcomes do you want and how can theybe achieved?• What is your action plan if this approachdoesn’t work?• What values, attitudes, knowledge and/or skills arebeing challenged in this situation?• How would you approach the situation next time? 99 Irwin, J. (2008), Professional practice supervision workshop, workshop handouts, Faculty of Education and Social Work, University of Sydney,22 August 2008.50 HETI The Superguide FIRST EDITION

Teaching usingthe treatment planWell-structured treatment planning is an excellentlearning experience that integrates communication,professionalism and clinical management.Supervisees learn techniques of clinical descriptionand case organisation when involved in planning andrecording treatment.Treatment planning is important to effective clinical care.The nature of oral health services means that treatmentmay have several different components and differentprofessionals may be involved in different aspects of thetreatment.The following issues are important intreatment planning:• Ascertaining the main presenting issue/sBeyond the basicsDo you use current best practice in recording yourtreatment plan so that all aspects of treatmentcan be clearly communicated to any treatingprofessional involved with your patient?If not, consider taking the time to develop a bestpractice model of a treatment plan. Not only willthis improve your own practice but it can alsobe an effective teaching tool you can useduring supervision.The challenge of treatment planning forthe supervisee• Being confident to speak up and be an activeparticipant in treatment planning.The educational role• Accurate and adequate history taking, includinggeneral medical health• Charting what is already there• Charting what needs to be done• Planning the order of treatment• Clearly documenting what has been done andwhat needs to be done so information is able to becommunicated to other professionals involvedwith the patient.Supervisors should discuss principles of good treatmentplanning to build the skills of supervisees and facilitatethe safe treatment of patients across occasionsof service.• Feeling able to ask questions if they are unsureof details in someone else’s treatment plan.• When writing a treatment plan, providing the mostcritical and relevant information in sufficient detailto ensure the issues are clear (just enough versus nottoo much). This is vital to continuity of care and safeclinical practice.• Ensuring time is prioritised in the daily schedulefor recording of patient information.• Ensuring effective and accurate documentationof patient issues occurs at all stages of treatment.• Maintaining patient confidentiality and privacy whileproviding appropriate treatment planning.FIRST EDITIONHETI The Superguide51

The educational roleFormal teachingAs a clinical supervisor and senior clinician, you may be required to give in-service training and presentations, andthe one clear advantage is that your subject will probably match your expertise. Practise these tips to make yourpresentations effective:• Consider your audience and shape your material to make it relevant to their current knowledge, clinicalresponsibilities and objectives. If in doubt, consider using questions at the start of your presentation to establishwhere to pitch your talk.• The first five minutes are vital. Capture interest with a compelling start (why should the audience listen?) andexplain what you intend to cover in your talk. If you have one key point above all, make it early.• When using PowerPoint slides, don’t dump all the information on the slide. White space, use of images anduncluttered slides with few words will ensure the audience pays attention to what you are saying.• Don’t read your presentation — most of all, don’t read your PowerPoint slides. Talk to your audience and maintaineye contact.• Stories, jokes and analogies are useful tools to make facts memorable.• Respond to visual cues from the audience to change pace. Ask a question if you are not sure that the audience iswith you.• Vary your delivery and technique. Consider breaking the presentation with questions to or from the audience, oran activity to be carried out by the learners.• Close your presentation strongly, with a summary of what you hope the audience will take away.• Avoid overstuffing your presentation with material. It is better to be succinct and cover key points than to tryto teach everything in one session.• Obtain feedback in order to evaluate the effectiveness of your teaching and make improvements next time.Beyond the in-serviceDon’t forget the broad spectrum of teaching methods available to you as a teacher as alternatives or adjunctsto providing in-services:• simulations and role plays• videos to demonstrate techniques or behaviours• group discussions, case studies and problem-based learning• computer-based education.52 HETI The Superguide FIRST EDITION

Beyond the basicsEven the simplest departures from the standardin-service format will make the content of youreducation sessions more memorable.Think creatively about your teaching methods.Are there new methods you can introduce thatwill better engage your supervisees and keep youmotivated and interested in your educational role?For example, some researchsuggests that adding “The patient’svoice” via videos of patients talkingabout their dental experienceshas a strong positive impacton learning. See: Schwartz, B. andR. Bohay (2012). “Can Patients HelpTeach Professionalism and Empathyto Dental Students? Adding PatientVideos to a Lecture Course.”Journal Of Dental Education,76 (2),174-184.You could also consider using anexperiential learning approachto teaching communication skillsinvolving realistic clinical scenariosand simulated patients.See: Lucander, H., Knutsson,K., Salé, H., & Jonsson, A. (2012).“I’ll never forget this”: evaluatinga pilot workshop in effectivecommunication for dental students.Journal Of Dental Education, 76(10),1311-1316.Teaching remotelyClinical consultations and episodes of supervisionmay take place over the phone, via email or videoconferencing. Despite the distance, the supervisor’sadvocacy for patient safety is no less than when presentat the point of care. There is a tendency to abbreviatephone calls to a minimum of information exchange,but the phone can be used to put the supervisor“virtually there” with the supervisee during clinicalencounters. Because the supervisor cannot seeor touch the patient, there is an increased focuson the supervisee’s communication skills.Particularly in non-urgent contexts, the supervisorcan work with the supervisee to develop his/her phonecommunication technique:• Provide feedback to the supervisee on the selectionand presentation of clinical information.• Practise the “report-back” technique of confirmingthe content of a phone communication with thesupervisee (repeat the essence of what you havebeen told and repeat the decisions for action thathave been made).Fear of difficult conversations with supervisors candiscourage supervisees from making a phone call atthe time when it is most needed. Supervisors needto support supervisees’ use of the phone/teleconferencing and other communication systemsand develop their skills in presenting informationsuccinctly and accurately to elicit the support andadvice required. (Consider using the SNAPPS method,see page 47.)Critical responsesThe educational roleAlso consider varying the design ofyour PowerPoint presentations. See:Kinchin, I., & Cabot, L. (2007). Usingconcept mapping principlesin PowerPoint. European JournalOf Dental Education, 11(4), 194-199When there is a critical incident, and there is no timefor explanations, it is important to make time to reviewthe event afterwards.FIRST EDITIONHETI The Superguide53

The educational roleTeaching non-clinical skillsTime management and setting prioritiesOne of the hardest skills to master is the effective prioritisation of clinical work to meet the needs of patientsand service demands. This is a skill which takes time to develop and is often difficult even for the most experiencedclinicians. An inability to effectively prioritise workload can leave clinicians feeling overwhelmed and overlookingessential tasks which need to be completed to facilitate the delivery of safe patient care.In addition, being a productive member of a discipline specific or multidisciplinary team requires completionof administrative tasks, projects and quality improvement activities on top of day-to-day clinical work.In assisting the supervisee to develop skills in time management and prioritisation, the supervisor can guide theperson to implement some of the following strategies:• quarantining specific sections of the day for direct patient contact activities and back of house activities;• managing unexpected interruptions and learning to say “no” or “at another time” when appropriate;• prioritising patients in order of urgency/risk;• creating “to do” and patient activity lists;• scheduling time during each day to complete documentation tasks;• allocating a specific time to make phone calls (e.g. making phone calls in 15 minute blocks);• setting time aside to respond to emails/complete statistical requirements once a day;• being flexible to reprioritise work on a daily or even hourly basis.Further time management tips can be found on page 106 in the form of a handout that can be given to yoursupervisee.54 HETI The Superguide FIRST EDITION

part fourThe supportive roleThe supportive roleThe quality of the relationship between the supervisor and thesupervisee is the most important factor of effective supervision.Kilminster, S. & Jolly, B. (2000). Effective supervision in clinical practice settings:a literature review. Medical Education, 34(10), p. 828.

The supportive roleThe supportive role of the supervisorEffective clinical supervision relies on a supportive and healthy interpersonal relationship between the supervisorand supervisee. This helps to create a positive learning environment in which the supervisee can grow professionallyand personally, while managing the challenges of the workplace setting.The supervisor should aim to create a safe place that allows the supervisee to discuss concerns, raise issues andreview mistakes without compromising patient safety.A supportive clinical supervisor can:• help build the supervisee’s confidence and sense of professional identity;• foster autonomy;• offer encouragement and reassurance when necessary;• debrief after problem situations;• discuss issues of concern in a non-confrontational and helpful manner;• be a resource for ideas on managing workplace challenges such as organising and prioritising work, timemanagement, goal setting, and problem-solving;• help the supervisee identify and manage stress;• direct the supervisee to other appropriate pathways of support where necessary (e.g. Student Services orEmployee Assistance Program);• engage in active listening;• help manage workplace relationships;• model effective communication skills and help the supervisee develop these;• give guidance on managing the therapeutic relationship between the supervisee and patient.What makes an oral health professional feel valued?• Being supported, especially when confronted with clinically challenging situations or while working in isolation,or outside the normal clinical environment including community visits• Being given responsibility for patient care• Good teamwork• Receiving feedback• Having a supportive learning environment• Being stimulated to learn• Having a supervisor take a personal interest in their work and professional development. 11 Peyton, J. (1998). The learning cycle, in Peyton, JWR, editor, Teaching and learning in medical practice, Manticore Europe Ltd, Rickmansworth: UK, 13-19.56 HETI The Superguide FIRST EDITION

Tips to foster engagement of the superviseeThe supportive role• Do the groundwork when establishing a newsupervisory relationship. Developing mutuallyagreed expectations of supervision builds a solidfoundation and helps address any future issues.• Ensure you demonstrate to the supervisee thatyou view supervision as a priority - make surethat supervision time is not hijacked by othercompeting demands.• Regularly seek feedback from the superviseeabout the quality of the relationship and thecontent of supervision.• Be prepared to tailor supervision to meet thespecific and changing needs of the supervisee.• Address disengagement as a matter of priority.• Develop an understanding of the supervisee’s(and your own) learning preferences and use thisinformation to strengthen the learning and makesupervision more meaningful.• Review the logistics around supervision such astiming, venue and frequency, and ensure theycontinue to be suitable and are not impacting onattendance.• Think of supervision as building on strengthsrather than working on deficits.• Be mindful that supervision can be anxietyprovokingfor some supervisees, and ensureexpectations are realistic and achievable.• Regularly find opportunities to give positivefeedback when the supervisee successfully usesthe learning from supervision in their practice.This not only reinforces the value of supervisionand increases the supervisee’s clinical confidence,it also ensures that patients receive quality care.FIRST EDITIONHETI The Superguide57

The supportive roleCommon challenges for supervisorsThe goal of supervision is to bring out the best in every supervisee. There are often challenging moments on theway to this goal. The challenges are unique to the individual and require solutions tailored to the circumstances.Many problems can be avoided by carefully orienting the supervisee to their role and to the organisation, settingclear expectations and establishing a supervision contract. This will go a long way towards preventing anymisunderstandings and alert the supervisor to issues that may need management.It is recognised that most clinicians receive little or no formal training in managing supervisee issues and oftenacquire these skills through experience and/or modelling other senior staff behaviour. It is important that supervisorsand managers invest in their own professional development and supervision to improve confidence in managingcomplex issues.Many factors may affect a supervisee’s performance. Some of the more common issues (and potential responses)are listed on the next page. The first response to any problem should involve a face-to-face discussion with thesupervisee.If the issues involved are sensitive, this should be conducted in a private location, free from interruptions and at atime when neither is distracted or overstressed. See pages 63-67 for tips on having a crucial conversation.If the issues are serious or if attempts to resolve the issues are failing, it is appropriate to seek additional assistance.In particular, if supervision is provided separate to line management responsibilities, the line manager should beconsulted. See pages 61-62 for advice on managing a supervisee in difficulty.58 HETI The Superguide FIRST EDITION

Common challenges for supervisorsThe supportive roleChallenges and solutionsThe supervisee with communication problems:Does the supervisee recognise that communicationis a problem? If yes, remediation can be relativelystraightforward (e.g. writing courses, conversationalpractice, providing scripts or templates to modeleffective communication practices, providing a mentoror buddy, use of audio-visual equipment).See pages 88-90 on building communication skills.A handout on communication skills which can be givento your supervisee can be found on page 104.If no, then the issue is more complex because thesolution has to begin with the supervisee gaininginsight into the problem. For example, members of theclinical team may report that the supervisee is impoliteand uncommunicative while the supervisee considersthat he/she is efficient and focused. Readjusting thesupervisee’s perceptions involves developing his or herempathic ability and, if identified as a problem, shouldbecome the focus of supervision.The supervisee who is uninterested in the area of clinicalwork: It is best to identify this early and plan accordingly.In some instances, the supervisee’s lack of interest willbe based on a misconception of the content of thework or on a failure to appreciate its relevance to theirarea of interest. In many cases, the supervisor canhighlight aspects of the work that will be of interestto the supervisee. In others, an appeal to thesupervisee’s sense of responsibility to the team maymotivate them.The reluctant supervisee: Where the supervisee hasno interest or cannot see the benefit of supervision,they needs to be encouraged to see the importanceof supervision as part of professional development anddelivery of safe patient care. Ensure the supervisoryrelationship and process appropriately meets the needsof the supervisee.The overconfident supervisee: Overconfidence ispotentially dangerous and it is important to provide areality check at an early stage. This may occur by askingthe supervisee to provide advice on a hypotheticalcase and then through guided questioning, givea constructive critique of their management plan.Consider highlighting the potential consequencesof overconfident practice in relation to a real patient.This should never be done in a way that will belittle orembarrass the supervisee.The perfectionist supervisee: Some supervisees are sodetermined to do everything perfectly that they cannotmeet realistic deadlines and are in danger of burningthemselves out. It is important with these superviseesto develop an appropriate priority list and work onrealistic time management skills. A handout on timemanagement which can be given to your supervisee canbe found on page 106.FIRST EDITIONHETI The Superguide59

The supportive roleStress managementResearch suggests that oral health trainees can be prone to high levels of stress and that trainee anxiety duringdental procedures can exacerbate the distress of their patients. 2Keeping in mind the importance of patient care, dealing with a stressed supervisee is crucial. As a clinicalsupervisor, managing your own stress levels is also important - stress is not confined to the new trainee!Part of the supportive function of supervision can be to help supervisees recognise and manage unhealthylevels of stress.Some of the stress faced by student and new graduate oral health professionals can arise from:• evaluation of their academic and clinical performance• fear of failure• managing professional relationships• inconsistent feedback• feeling criticised• developing and maintaining a professional identity• managing workload• having full responsibility for patients• personal life stressors• managing time effectively• completing administrative tasks. 3If you become aware that your supervisee is excessively stressed, you need to address this. On the next few pagesare some tips for managing a supervisee in difficulty.If your supervisee is showing just minor levels of stress, you could address this by giving them some stressmanagement tips. A handout on stress management that you can give to your supervisee can be found on pages109-110 in the Handouts section.Be mindful that while minor levels of stress may be addressed within the supervisory relationship, it is not thefunction of clinical supervision to provide counselling for the supervisee. If you feel that the supervisee needs furtherhelp, direct them to the appropriate support services.2 Piazza-Waggoner, C., Cohen, L., Kohli, K., & Taylor, B. (2003). Stress management for dental students performing their first pediatric restorativeprocedure. Journal Of Dental Education, 67 (5), 542-5483 Murphy, R., Gray, S., Sterling, G., Reeves, K., & DuCette, J. (2009). A comparative study of professional student stress. Journal of Dental Education, 73(3), 328-337.60 HETI The Superguide FIRST EDITION

Managing a supervisee in difficultyThe supportive roleOver the course of supervision, challenging situationsmay emerge that lead to your supervisee notprogressing as they should and potentially placingthemselves and others at risk. They could becomea “supervisee in difficulty”.A supervisee in difficulty may be supported by both thesupervisor and operational line manager.Clear processes defining the role of each person arerequired in the case where the line manager is not theclinical supervisor. Where there are specific clinicalpractice issues, a suitably qualified senior clinicianfrom that discipline should be involved in the process.It is important to recognise that, in the case of lessexperienced supervisees, being a junior oral healthpractitioner with limited experience can be challenging.Most problems can be resolved if they are appropriatelyidentified and managed. The general approachto dealing with supervisees in difficulty rests on threeprinciples:The saying “prevention is better than a cure” applieshere. Being astute and responding to issues earlyprevents a situation escalating to a major incident.When a supervisor encounters a supervisee in difficulty,he/she should seek advice without delay.Experience has shown that simple interventions canbe very effective if made early enough. Seek adviceearly from your line manager, other senior colleaguesor workforce services department. Other units suchas the employee assistant program and professionalpractice unit may also be of assistance to bothsupervisors and supervisees.1. Patient safety should always bethe primary consideration.2. Supervisees in difficulty require ongoingsupervision and support.3. Prevention, early recognition and early interventionare always preferred over a punitive approach indealing with identified issues.FIRST EDITIONHETI The Superguide61

The supportive roleProcess for managing a supervisee in difficultyThe flow diagram below outlines a useful process to facilitate managing a supervisee in difficulty.Assess the severityConcern expressedabout trainee• Patient safety?• Trainee safety?• Misconduct?Preliminary assessment of concernConsider potential underlying issuesConsider need for further investigationSpeak with traineeListen and assessConsider seeking advice from HR/DMSFurther investigationNote findingsConsider referral to expert practitionerAgree action plan and review dateSeek agreement of traineeDocument the action planImplement action planEnsure trainee is adequately supportedReviewReach a conclusionMatter resolved or requires ongoing review or referralSource: NSW Institute of Medical Education and Training 2009, Trainee in difficulty. A handbook for Directors of Prevocational Education and Training.62 HETI The Superguide FIRST EDITION

Steps in a crucial conversationThe supportive roleWhen you are concerned about some aspectof your supervisee’s performance, skills, or attitudeit is important that this is addressed so that theproblems don’t continue. Many problematic issues canbe addressed through crucial conversations betweenthe supervisor and supervisee.Such conversations can:• alert the supervisee to the problem/s• clarify expectations• propose solutions• establish consequences for failing to changeIt is important to plan carefully for a crucial conversation.Below are some steps to follow that will maximise theeffectiveness of your next crucial conversation.Step 1. PrepareStep 2. Develop the frameStep 3. Conduct the conversationStep 4. Conclude the conversationStep 1. PrepareThere are four key factors to consider before beginninga crucial conversation:• Agenda: What do you want to achieve?• Time: Allow time to cover all the issues properly.A crucial conversation should not be rushed or carriedout on the run.• Place: Choose a setting where you will be undisturbedand where your supervisee will have the opportunityto respond appropriately.• Mindset: Consider the mindset of both you and yoursupervisee. A crucial conversation should take placewhen neither of you is stressed or upset and you areboth able to give the matter the attention it needs.Step 2. Develop the frameDevelop the frame of your conversation in advance.There should be a clear outcome in mind.Consider the following potential ways to framethe conversation.Anticipating“I wanted to have a brief chat about how your treatmentplanning is going. Nothing has happened that gives mecause for concern, I just wanted to see if it is all goingOK and if there is anything you need from me.”Contrasting“The last thing I want to do is give you the impressionyour opinion is not valued. I would really like to hearwhat you have to say because I think you have animportant perspective on this.”Desired outcome“It would be great if we could leave the meeting witha clear action plan. How does that sound to you?”Desired process“It is always hard to talk about communicationdifficulties. I would really like us to try and understandeach other’s needs before we decide on the next step.”Common purpose“I guess it is important to note that we are bothcommitted to providing quality patient care.”Asking permission“I think this is an important issue and there is a lot ofpotential benefit if we can get it solved. Is it OK if I asksome difficult questions?”Set the frame of reference early in the conversationand revisit it during the conversation to keep youboth on track.FIRST EDITIONHETI The Superguide63

The supportive roleStep 3. Conduct the conversationSTATE your path:Share the factsTell your storyAsk their storyTalk tentativelyEncourage testingShare the factsStick with the observable facts and avoid judgements.Share the facts Example NotWhat I noticed was...“What I noticed was that you weretexting during the meeting.”“You clearly did not consider themeeting important!”When X happened you did Y “When Peter started talking, yourolled your eyes.”“You really dislike Peter.”Tell your storyOwn the story as yours and avoid black and white pronouncements.Tell your story Example NotWhen that happens it appearsto me...“When that happens, it looks tome as if you don’t consider the“You obviously don’t want to bethere.”meeting important. Is that what washappening for you?”The story I tell myself about that is... “The story I told myself about thatwas that you find Peter tedious.Is that right?”“You think you are above the restof us.”64 HETI The Superguide FIRST EDITION

The supportive roleAsk their storyBe genuinely curious. It’s about understanding their experience.Examples:• What was going on for you?• What were you trying to achieve?• What led you to that decision?Talk tentativelyBe aware you don’t have a monopoly on reality. Leave yourself some room to re-evaluate based on new information.Examples:• Is that accurate?• Is that how you see it?• Am I missing something important here?Encourage testingLook out for untested assumptions. Check for blind spots.Examples:• What other ways could we look at this?• Is there another explanation for what they did?• Are you sure they would reject that approach?• How else might others experience this?FIRST EDITIONHETI The Superguide65

The supportive roleStep 4. Conclude the conversationKeeping in mind the frame you developed, conclude with an action plan. You need to collaboratively discussthe plan with your supervisee and agree on options for moving forward.Consider the following:• What will be done and by whom.• Build ownership by giving them as much lead in developing solutions as possible.• Develop SMART goals (See tips on pages 98-99.)Examples:• How can we move forward?• Any other options?• What do you think would work best for you?Having a “crucial conversation”You have noticed that a supervisee is having difficulty with workload management. You know thisbecause you have noticed that she is frequently staying back to get work done, is often workingthough lunch and looks exhausted and overwhelmed. You are also taking note of the issues thesupervisee brings to supervision and you are finding that the supervisee is taking on too much extrawork. You suspect that the supervisee is doing “above and beyond” the work that is required becauseshe does not understand her role and is therefore anxious about performance and unsure aboutboundaries. You decide to address this in the next supervision session. This entails having a ‘crucialconversation’ with the supervisee.Step one: PrepareThe agenda: You would like to clarify role expectations and boundaries with your supervisee and to develop a planwith her to better manage her workload. You decide that the best time to have the crucial conversation is in thesupervision session planned for next week. This will take place in your office where you won’t be disturbed, andwhen you will both be in the appropriate mindset for addressing this sort of issue.Step two: Develop the frameYou decide to frame the conversation as sharing a common purpose:“It seems that we both think it important that you develop into the best clinician you can be. I would like to takesome time today to discuss workload management.”66 HETI The Superguide FIRST EDITION

Step three: Conduct the conversationThe supportive roleShare the factsTell your storyAsk their storyFocus on observable facts andbehavioural evidence.Be constructive and specific.Using “I” statements can be helpful here– make it clear that you are telling thestory from your point of view.Use active listening skills (empathy,questioning and open body language)and show genuine interest when tryingto find out the cause of the issues.“I wanted to share with you some thingsI have noticed over the last few months.I have noticed that you are staying backlate on a regular basis and often nottaking lunch breaks”“I feel really concerned that you maybe overdoing it at work. I am wonderingwhat sort of an impact this is havingon you?”“How are you feeling about yourworkload and how you are managing it?”Talk tentativelyEncourage testingCheck your understanding of what theyhave said and put forward suggestionsrather than definite statements.Collaboratively explore strategiesand support options to help addressthe issue.“So it seems that you are sayingyou aren’t always sure what is yourresponsibility and you would rather makesure everything is completed before youtake a break than risk being judged asunprofessional or lazy. Is that right?”“My job as your supervisor is to ensureyou are supported in all areas of yourwork. Do you think there could be otherways to manage your workload that stillleave you feeling professional?Step four: Conclude the conversationSteps and timelinefor improvementResponsibility should be shared whenlooking for solutions.Mutually agree on one or two steps,strategies, solutions or support optionsthat are realistic and achievable within atime frame.Develop a SMART goal.(See tips on pages 98-99.)“So, we have agreed that over the nextmonth we will meet once per weekinstead of once per fortnight.Let’s make a time now for a sessionnext week.For our next session, I will find somematerial for you to read in regard toworkload management and you will keepa reflective practice log.”FIRST EDITIONHETI The Superguide67

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part fiveThe administrative role“Managers have an imperative to become involved with peopleas superiors, peers and subordinates. They create work conditionsthat enhance productivity and engender commitment. They achieveresults through people by selecting the right people, designingmeaningful jobs, developing their staff skills and career prospects,setting standards, rewarding good performance, and offeringongoing support and encouragement”.The administrative roleLawson, J. & Rotem, A. (2004). From clinician to manager: An introduction to hospitaland health service management. McGraw-Hill Australia Pty Ltd, North Ryde,(2nd edition) p. 77

The administrative roleClinical supervision and operational managementDue to the diverse nature of clinical working environments in oral health, there are times when the clinical supervisoralso performs an administrative role in relation to the supervisee.Both good supervision and staff management are essential to support supervisees. Whilst they can be seen asseparate processes they are in fact complementary and must coexist. Some of the literature supports the separationof clinical supervision activities from management activities due to the inherent power imbalances which exist withina line management relationship. 1 It is acknowledged, however, that in many settings these roles are often performedby the same individual. In such situations, appropriate management of the separate roles is important. One way ofmanaging this is by clarifying the nature of the supervisory role through contracting (see page 81).The table below outlines some of the differences between clinical supervision and operational management.Clinical supervision• Driven by the clinical developmentneeds of the supervisee• Targeted to promoting patient safety• Facilitates skills acquisition• Provides a forum for discussion of ethicalpractice issues• Promotes reflective practiceOperational management• Promotion of positive working relationshipsbetween individuals and teams• Managing for performance• Management of human resource issuessuch as staff development, mandatory trainingand annual leave• Allocating and monitoring workload or caseloadproactively in collaboration with the supervisee.Adapted from Allied Health Clinical Support Framework, Country SA, SA Health, May 2009, p 36.1 Smith, M. (1996, 2005), The functions of supervision’, The encyclopedia of informal education, Last updated September 2009.70 HETI The Superguide FIRST EDITION

Managing clinical staffKey tasksThe administrative roleThe purpose of administration is to promote andmaintain good standards of work, including ethicalpractice, accountability measures and adheringto policies where they exist.When the clinical supervisor is also the line manager,this can include the following tasks in relationto the supervisee:• clarifying roles and responsibilities• workload management• review and assessment of work• addressing organisation and clinical practice issues.There are some administrative tasks requiredto support a supervisee which have an important rolein clinical education and training. These activities maybe performed by the line manager, supervisoror collaboratively between the two depending on localservice arrangements.Include but are not limited to:1. orientation;2. managing for performance (to promote andencourage progress);3. being or sourcing mentors, coaches and buddies;4. managing supervisees in difficulty. This can also formpart of the supportive role of clinical supervisionand is described on pages 61-62.FIRST EDITIONHETI The Superguide71

The administrative roleOrientationOrientation is the key to effectively introducing a new supervisee into the clinical area or facility andsetting up the supervisory relationship. Supervisors are often responsible for organising or participating in orientationfor new supervisees, even if they delegate parts of the orientation to other staff. Where appropriate, multidisciplinaryorientation should be considered as it immediately begins to meld the supervisee into the clinical team.Oral health professionals highly value a formal orientation. Not orienting a supervisee sends some strong negativemessages about the professionalism of the team they are joining. Lack of orientation is often a root cause of laterproblems that supervisees may experience as they settle into their new role.It is useful to have a checklist to ensure that orientation is comprehensive (see next page).Wherever possible, include a face-to-face handover to a new supervisee. A succinct (written or digital) orientationpackage is an excellent welcome gift. Such packages need regular updating.Orientation provides the supervisor with the opportunity to review the supervisee’s current level of knowledgeand experience and to develop a plan to meet their particular learning goals.Benefits of a successful orientation extend to the whole clinical team. With a multidisciplinary, interprofessionalcollaborative practice approach, teamwork and collaborative relationships are promoted and staff can be bettersupported. In addition, patients will receive better care when all members of the team use standard proceduresand protocols.72 HETI The Superguide FIRST EDITION

Checklist for orientation:Orientation should include:55the major focus and goals of the clinical teamand the expectations of the supervisee’s role55roles and responsibilities of the superviseeand other members of the team55three month review(or as per organisational requirements)55expected daily tasks55hints for successful interactions withother staff members (who is on the team– key team members and their roles)55procedures for making referrals to internaland external service providers55other administrative procedures, includingdocumentation55supervision needs55learning objectives and skills training goals55information about professionaldevelopment opportunities55general information about work practices,protocols and guidelines as they apply55the process of annual formal review.Beyond the basicsWhy not consider developing an orientationpackage for new supervisees and/or staffmembers?The administrative roleFIRST EDITIONHETI The Superguide73

The administrative rolePerformance development and reviewPerformance development and review is generallyundertaken by the operational line manager, which mayinclude a unit head, team leader, head of departmentor service manager. This may be the clinical supervisorif they are also the line manager. However, if the clinicalsupervisor is not also the line manager they may still beinvolved in this process. This provides an opportunityfor collaboration to occur for the benefit of thesupervisee.“Managing for performance is a process thatcommences with the recruitment and orientation of anindividual and involves an on-going cycle of planning,coaching and reviewing individual, work, team andorganisational performance within the contextof the organisation’s goals and strategies” 2It is important to note that performance developmentand review is not disciplinary action but is about ongoingtwo-way feedback to promote development. It may alsoinvolve a formal review, often referred to as the annualperformance review.Purposes of the formal review• To provide supervisees with feedback about theirperformance and facilitate their learning anddevelopment.• To review evidence that supervisees are progressingand achieving their learning objectives. A good reviewsystem should assure senior staff/management thatoral health professionals are meeting certain standardsof practice and competence before advancingto higher levels of responsibility.• To set objectives for the following year and identifyareas for professional development in line with serviceneeds and the supervisee’s career aspirations.For more information, please refer to the NSW HealthPolicy Directive, PD2005_180, Performance managingfor a better practice approach for NSW Health 2005.The process of clinical supervision links into the formalreview as it is based on individual learning goalsrelating to clinical practice. These items can thereforebe discussed in addition to the organisation/servicerequirements of the supervisee.If supervision has been effective throughout the year,there should be no surprises at the formal review.The supervisee should be well aware of the progressthey have made and the opportunities for furtherimprovement. This should be achieved through regular:• feedback on performance• review of learning goals• one-to-one supervision sessions to discuss progressand opportunities for improvement• use of reflective practice to develop increasedself-awareness.2 NSW Department of Health 2005a, NSW Health Policy Directive, Performance managing for a better practice approach for NSW Health 2005, viewed on4 April 2013, p. 4http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_180.pdf74 HETI The Superguide FIRST EDITION

Mentors, coaches and buddiesThe administrative roleCoaching and mentoring can be used to complement an existing supervisory relationship or when the supervisorfeels he or she does not have specific knowledge, skill and expertise in a particular area of the supervisee’s interest(such as research) or a specific therapeutic modality. In this situation, the supervisor can source support from anappropriate colleague to act as a mentor or coach to the supervisee.Providing a mentor, coach or buddy can be an effective way of:• introducing a supervisee to a new facility or a new clinical area;• supporting personal and professional growth and development;• helping a supervisee in difficulty by giving an extra avenue of support;• building closer links within and between clinical teams.Mentoring has been described as a “developmental, caring, sharing and helping relationship where one personinvites time, know-how and effort in enhancing another person’s growth knowledge and skills”. 3Coaching is a solution-focused approach used to assist people to retrieve and utilise their personal experiences,skills, intuition and expertise in order to find creative, individual solutions to work and personal life situations. 4Buddies are pairings of clinicians (usually one who is more experienced than the other) for similar purposes.Informal mentoring, coaching and buddy relationships can naturally form in the clinical environment. They can alsobe formalised and deliberately fostered by supervisors as a support to clinical supervision. These relationships canalso form the basis of a peer supervisory relationship. Some mentors and/or coaches have skills obtainedthrough formal qualifications and training.It is important to note, mentors, coaches and buddies do not necessarily need to be from the same disciplineas the supervisee. Smith and Pilling 5 demonstrated that the use of interdisciplinary peer support was valued bynew graduate health professionals as part of an interprofessional education program.Generally speaking, a formal mentor, coach or buddy to a supervisee should not be their supervisor as the rolescan conflict.3 Shea 1999, p. 3, cited in McCloughen, A, O’Brien, L & Jackson, D (2009). Esteemed connection: creating a mentoring relationship for nurse leadership,Nursing Inquiry, 16, 326-336.4 Greene, J. & Grant, A. ( 2003). Solution-focused coaching: managing people in a complex world. Momentum Press, Great Britain.5 Smith, R. & Pilling, S. (2007). Allied Health Graduate Program – supporting the transition from student to professional in an interdisciplinary program,Journal of Interprofessional Care, 21 (3), 265-276.FIRST EDITIONHETI The Superguide75

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part sixThe supervisor’stoolkit– activities“Due to advances in education ... educators today are requiredto have an expanded toolkit of teaching skills and clinical expertise.”The supervisor’s toolkit - activitiesRamani, S. & Leinster, S. (2008). AMEE Guide No. 34: Teaching in the clinicalenvironment, Medical teacher, 30, p. 362.

The supervisor’s toolkit – activitiesResources for supervisionIn this section you will find a set of resources to assist you in providing effective clinical supervision.We have organised these resources into three sub-sections:1. Clinical supervision activities: 2. Handouts for supervisees: 3. Templates:These activities are to give youinformation and guidance on somecore supervisory activities. We feelthat these activities cross over thethree functions of supervision.These can be used to provideinformation and tips for superviseeswhen you identify a need.For common supervisory toolsand activities.Beyond the basicsWhy not add to these resources and build your own toolbox?Peer supervision is a useful way of sharing resources and ideaswith other supervisors and this can further develop your stockof useful resources.You will also find a lot of useful resources available from universitiesand other sources. Ask around!78 HETI The Superguide FIRST EDITION

Establishing the supervisory relationshipIt is important to get to know your supervisee as a person and to establish a good working relationship at the outset.If you show your interest in them and their aspirations, this is likely to form the basis of a successful supervisoryexperience for both of you. Part of this initial relationship building is introducing yourself and explaining a littleof your background and your goals for supervision. it is also important to establish clear boundaries and a jointunderstanding of the supervisory relationship.The educational supervisor’s role toolkit – activitiesFor the new practitioner, the early period of the supervisory relationship is part of what is known as “professionalsocialisation”. This is the process of learning skills, attitudes, and behaviours necessary to fulfil professional roles.Brim 1 describes socialisation as preparing adults for roles so they will know what is expected of them, will meetthose expectations, and will desire to practise the expected behaviours.Early professional socialisation is influenced by multiple factors including self-concept, personal and educationalbackground, and the role of mentors, peers, and role models. 2Some questions to help build the initial supervisory relationship include:• What are your expectations of this role and of supervision?• What long term goals/aspirations do you have for your career?• What have you found challenging in the past?• What do you see as your area/s of special competence?• How do you learn best?• What level of support do you think you need?• Do you have any concerns that we need to address before you start here?• Is there anything else that you think it might be helpful for me to know?The supervisor should also discuss and establish:• the frequency of supervision sessions;• their availability and willingness to be contacted when assistance is required;• the best way for the supervisee to access advice on a day-to-day basis;• how concerns can be addressed.Taking the time to establish a joint understanding of the processes and boundaries of supervision from the startprovides a solid foundation from which to manage issues or concerns as they arise.1 Brim, O. (1968). Adult socialization. In: Clausen, J. (ed) Socialization and society. Boston: Little Brown, 182-226.2 Blue, C. M., & Lopez, N. (2011). Towards building the oral health care workforce: who are the new dental therapists? Journal Of Dental Education, 75(1),36-45.FIRST EDITIONHETI The Superguide79

The supervisor’s toolkit – activitiesGetting to know your supervisee’s skill levelWhen entering a new supervisory relationship, you need to establish the skill level and prior clinical experience of thesupervisee before supervision can proceed. For example, an oral health practitioner may move from a teaching clinicwhere they are confident in working with adult clients to private practice where they will be working with children.While they may be skilled in appropriate treatment approaches, they may require further development of specificskills under supervision for working with children before completing these tasks independently.Patient safety comes firstWhere is your superviseeon the learning curve?Have you checked their skills?Patient safety is a core responsibilityof all clinical staff that cannot be delegatedThe clinical care and safety of the patient is the responsibility of all health care professionals. It is importantto be clear about the clinical skills of the supervisee, whether they are a student, new graduate or moving intoa new clinical area, so that they are not exposed to situations for which they are unprepared.To ensure patient safety it is critical that the supervisor:• discusses the intervention plan for the patient with the supervisee to facilitate clinical reasoning and decisionmaking to ensure safe patient care;• routinely oversees patient care as required to ensure that oral health professionals are acting competently;• is vigilant to detect triggers for a need for further involvement (to prevent or correct errors by the superviseeor to escalate care);• is accessible when assistance is sought or ensures there is someone else to go to when the supervisor is absent.It is far better for supervisors to be actively engaged in supervision that prevents errors and maintains standardsthan to attempt to manage problems after the event.80 HETI The Superguide FIRST EDITION

Supervision contractAn effective way to ensure that expectations of thesupervisory relationship are clear at the outset isby completing a supervision contract. Whilst this isseparate to the performance development and reviewprocess, the two are both linked to productivity andperformance of the individual supervisee.A supervision contract is a document which outlinesthe parameters of the relationship including theresponsibilities of each individual. It is signedby both parties and forms the basis of the supervisoryrelationship. A copy should be kept by the supervisor,supervisee and the line manager (if applicable)in a central file as a reference document.Items covered in a supervision contract may include:• requirements as outlinedin the local supervision policyConfidentialityConfidentiality is vital to supervision. Agreeing on theparameters of confidentiality protects personal andsensitive information and upholds professional integrity.Confidentiality should be discussed as partof establishing the supervision contract. This Includes:• mutually agreed reporting procedures if duty of careissues are raised by the supervisee• mutually agreed reporting procedures if the supervisorhas duty of care concerns pertaining to the supervisee• agreement in relation to what feedback can be givento the line manager• ensuring discussions are held in private anddocumentation is kept in a secure place.The supervisor’s toolkit – activities• goals of supervision• frequency and time allocation for supervision• parameters of confidentialitywithin the supervisory relationship• means of evaluation of the supervision process• the process for dealing with difficulties within thesupervisory relationship, e.g. if either party feels thesupervisory relationship is not working or that thecontract has been broken.Examples of supervision contracts are given in thetemplates section on pages 113-116.It is important for supervisees to be awarethat there are limits to a confidentialityagreement in the case of misconductor following adverse patient care events.Make sure to check your local policiesabout confidentiality and otherimportant guidelines.FIRST EDITIONHETI The Superguide81

The supervisor’s toolkit – activitiesDocumenting supervision sessionsThe agreed actions and outcomes of the discussions which occur during one-to-one supervision sessionsshould be documented on a supervision record form. This provides additional guidance to the supervisee regardingareas on which they need to focus, and records the agreement of both parties regarding actions they are committedto taking.Notes can be taken by either the supervisor or supervisee during the session. The documented record should ideallybe signed by both parties, who should each keep a copy.Supervision records are legal documents and in the context of misconduct or legal proceedings arisingout of adverse events may be used as evidence. Supervision notes must be objective and accurately maintainedaccording to NSW Health standards. For those working in the public health system, supervision notes should bestored for a period of time in line with NSW Government State record requirements.See records.nsw.gov.auExamples of a supervision session sheet and log sheet can be found in the templates section on pages 117-119.82 HETI The Superguide FIRST EDITION

Evaluating supervisionIt is important to have systems in place to evaluate thequality and effectiveness of supervision. Evaluationof the supervisory relationship is a joint responsibility ofthe supervisor and the supervisee. Perspectives of boththe supervisee and the supervisor should be included.The supervisor’s toolkit – activitiesThere are several ways to evaluate supervision,such as:• review of the supervision contract• regular review or reflective discussion throughout thesupervisory relationship• through a debriefing after a critical incident,misunderstanding or breakdown in communication• using an evaluation form or other formalevaluation process• through informal discussion.A useful feedback form which can be completedto evaluate the effectiveness of a one-to-onesupervisory relationship can be found in the templatessection on page 121.FIRST EDITIONHETI The Superguide83

The supervisor’s toolkit – activitiesActive supervisionActive supervision occurs when the supervisor is sufficiently engaged and vigilant to provide support when needed,whether or not a request for help is made. This should be a feature of ongoing supervision.Active supervision acknowledges that some supervisees, or all supervisees in some situations, are “unconsciouslyincompetent” - that is, they do not know what they do not know, and will not always recognise situations that arebeyond their current abilities where patient safety may be at risk. Active supervision requires the supervisorto continually seek clues or evidence that direct patient care or more support from the supervisor is required.In the learning cycle described by Peyton 3 , trainees move through four stages in the acquisition of particularcompetencies, from unconsciously incompetent to unconsciously competent.Knowing your supervisee’s competence levelKnowing your supervisee’s competence levelUnconciously incompetent:The trainee does not know what they do not know.Danger at this stage:An inadequately supervised trainee may unwittingly do harm.Response:Supervise closely (hands-on), and challengethe knowledge gaps of trainees.Conciously incompetent:The trainee know that they do not know.Danger at this stage:Trainee may avoid situations that test theirincompetence.Response:Supervise closely (hands-on), and challengethe trainee to overcome their inexperience.Unconciously competent:The trainee can perform the task competentlywith practiced ease.Response:The trainee no longer needs supervision inthis task. Get them involved in teaching itto others.Conciously competent:The trainee can, with thought, perform the taskcompetently.Danger at this stage:Atypical circumstances or pressure may cause thetrainee to fail despite previous success.Response:Supervise with hands off, provide praise,recognition, opportunities to practise.3 Peyton, J. (1998). The learning cycle, in Peyton, J. , (ed.), Teaching and learning in medical practice, Manticore Europe Ltd, Rickmansworth, UK, 13-19.84 HETI The Superguide FIRST EDITION

A key concept: hands-on, hands-offAn effective supervisor knows when to give supervisees “Hands-on” supervisiondirection and when to give them freedom of action.• Guidance on interventions that requireTo move the supervisee from consciously incompetentfurther skills developmentto consciously competent, the supervisor must activelycalibrate the level of support provided.• Specific skills training sessionsThe supervisor’s toolkit – activitiesIedema et al. 4 put forward a model of clinical supervisionthat recognises the need for support and independence.It was found that supervisees value supervisory supportof two kinds:“Hands-on” supervision — when the supervisor isdirectly involved in monitoring or helping the superviseeas he/she performs tasks.“Hands-off” supervision — when the supervisortrusts the supervisee to act independently, leavingspace for the supervisee to deploy emerging skills andtest growing clinical abilities. However, “hands-off”supervision is not the absence of supervision!In general, supervisees need more hands-onsupervision when tasks are new and increasing amountsof hands-off supervision as they progress and increasetheir skills, confidence and competence. Superviseesalso value an intermediate zone that allows themto shift back and forth between monitored (hands-on)and independent (hands-off) practice.• Seeing patients with supervisor• Discussing mistakes• Opportunities to discuss patient management“Hands-off” supervision• Identifying crucial supervision moments• Allowing room to develop independence• Feeling trusted• Providing opportunities for de-briefing and discussion.From a supervisor’s point of view, both hands-on andhands-off supervision are active processes, requiringthe exercise of judgment.To work out how much hands-on and hands-offsupervision your supervisee needs, it may be helpfulto ask yourself: How far along the trajectoryof development are they? When is it time to intervene?ExtractionYou find out that your superviseehas only done two extractions throughoutthe course of her training. Although shehas been deemed competent, she is notconfident at all. The two extractions shehad done were of mobile deciduous teethand now she is being confrontedwith having to extract a fully rootedbaby tooth on a six-year-old.How would you handle this situation,keeping in mind the principles ofhands-on/hands-off supervision?4 Iedema, R, Brownhill, S, Lancashire, W, Haines, M, Shaw, T, Street, J & Rubin, G (2008). Hands on, Hands off: A model of effective clinical supervisionthat recognises trainee’s need for support and independence, (Final Research Report for Institute of Medical Education and Training and Sax Institute),Centre for Health Communication, University of Technology, Sydney.FIRST EDITIONHETI The Superguide85

The supervisor’s toolkit – activitiesVoices fromthe fieldWhen I first started clinical supervisionI was unsure about the amountof direct and indirect supervisionthat students required. I soon felt morecomfortable with my supervision techniqueas I observed my colleagues and usedtheir skill and expertise as guidance.Voices fromthe fieldI enjoy my role as a clinical supervisorand rarely feel frustratedduring the clinical sessions.I am always happy to demonstratea procedure and often do sobut I don’t take over unless I have to.I was, and still am, very fortunateto work within a great team of other clinicalsupervisors; their ability has made me feelmore confident about the clinical supervisionthat I provide to students.86 HETI The Superguide FIRST EDITION

Risk managementFrom time to time, problems might arise in relationto your supervisee’s clinical practice. The first pointto remember is that prevention is better than cure!If your supervisee is carrying out a difficult andunfamiliar procedure for the first time, it is importantto talk them through all aspects of the procedure priorto starting. Consider detailing the steps to be carriedout, reviewing the xrays and treatment plan, discussthe placement of instruments, positioning of the chair,what they will say to the patient etc. Be clear up frontabout when you might need to intervene and how youwill do this if necessary. They need to know that you areboth on the same page and that you will be supportingthem throughout.The supervisor’s toolkit – activitiesIf you need to debrief a procedure that has not gonewell, first, clarify your supervisee’s understanding ofhow the procedure went. Give them the opportunityfor self-assessment and reflection before jumping inwith your opinion. If you find their understanding differsgreatly from yours, consult their teaching institution andcheck what they have been taught. Then come back tothem and clarify what went wrong and what the correctsteps should have been. Be clear about what they needto do and what your role is.Plan to observe them carrying out the same procedureagain at the next opportunity.If ongoing problems emerge that cannot be adequatelyaddressed through supervision, and if all other avenueshave been exhausted, you may need to report backto their teaching institution or professional body.Patient care must always be the main considerationand any risk to patient safety should be taken seriously.Refer to pages 61-62 for tips on managinga supervisee in difficulty.FIRST EDITIONHETI The Superguide87

The supervisor’s toolkit – activitiesCommunication skillsThe art of effective communication is a core skill for all oral health professionals. This is crucial in building rapportwith patients, during diagnosis and treatment, providing education to patients (e.g. about dental hygiene),discussing financial matters and waiting times, communicating with other team members, etc.The oral health worker needs to be able to communicate effectively with a range of audiences including thoseof a different age, gender, ethnicity, cultural background, religion, etc. and to adapt communication accordingly.Poor communication skills can impact negatively on the quality of patient care and interpersonal relationships.The supervisory relationship itself relies on effective communication between the supervisor and supervisee.If you become aware that your supervisee‘s communication skills need improvement, this should be addressedthrough using your own effective communication skills and by providing them with guidance and opportunities forskills building. (See also pages 94-95 for advice on giving feedback to your supervisee.)Active listeningThe art of active listening is a crucial communication skill that should be practised by the clinical supervisor duringsupervisory sessions.Active listening involves focusing on the supervisee when they are speaking to you in order to properly understandwhat they are saying. By listening carefully, you are able to show the supervisee you have understood what hasbeen said and this allows the supervisee the opportunity to provide more information if necessary.Active listening involves all of the following:• Focusing on key and relational words, e.g. what the supervisee is saying is happening to him or her.• Paraphrasing or summarising the key ideas in what the supervisee has said, e.g. “So what you’re saying is….”• Asking for clarification or more information if you are unsure of what they are saying or if you require moreinformation e.g. “Can you just tell me a bit more about...?” or “Is there anything more?”• Using prompts (or minimal encouragers) that encourage the other person to continue speaking, e.g. nod, smile,verbal prompts such as “ah ha” or “I see” etc.• Displaying non-verbal behaviour that lets the other person know you are paying attention to what they are saying(see next page).88 HETI The Superguide FIRST EDITION

Communication skillsNon-verbal communicationNon-verbal communication can be just as important aswhat is actually said so try to consider this as well.The following acronym, can help you remember somekey factors in non-verbal communication.S – Face the person squarelyThe supervisor’s toolkit – activitiesWhen communicating important messages, be awareof the volume and tone of your voice, your physicalgestures, and facial expressions. Body language is animportant component of communication and can havea big impact on how a message is received.An open posture, calm voice, and relaxed bodylanguage help communicate your message in anon-threatening way and this makes it more likelythat the message will be heard and understood.O – Open posture, no crossed arms or fidgetingL – Lean towards the person, not too muchbut just enough to show interestE – Maintain eye contact, without staringR – Be relaxed and comfortableFurther communication tips can be found onpage 104 in the form of a handout that can be givento your supervisee.Reflective practiceAre you aware of the strengths and limitations of your own communication style as a clinical supervisor?Do you consider the impact of differences (e.g. in power, status, gender, experience, age, ethnicity, religion)between you and your supervisee on how you communicate with each other?How effective are you in the art of active listening? Try consciously practising and evaluating your active listeningskills in your next interaction with your supervisee.Beyond the basicsThere are several Youtube videos and podcasts available on the internet, some specific to oral health,that demonstrate good communication skills and the art of active listening. Try searching for and viewingsome of these to remind yourself of the techniques of good communication.Try these search terms on YouTube:oral health, patient, communicationIf you find a video particularly useful, this canbe added to your Supervisor’s toolbox as a resourcefor supervisees who need to develop skills in this area.FIRST EDITIONHETI The Superguide89

The supervisor’s toolkit – activitiesCase study: Developing communication skillsYou are supervising a new graduate, Pat, who has excellent clinical skills. However, you have noticed that Pat doesnot communicate well with patients and this seems to be having a detrimental effect on the patients’ level of stressduring procedures.Pat is about to start a procedure and the patient expresses fear about how much the procedure might hurt.Pat looks uncomfortable and gets ready to start the procedure without saying anything further to the patient.The patient seems to be getting more stressed and uncomfortable. What next?Path oneYou feel uncomfortable on behalf of both the patientand Pat but don’t want to interrupt or take overbecause that might undermine Pat in front of thepatient so you say nothing.You make a mental note to comment on Pat’s poorcommunication skills when completing your progressreport.Pat completes the procedure successfully but by theend the patient is a bit tearful and shaky.You wait until you are writing the progress report tohighlight the problem. You discuss the issue with Patwhen reviewing the progress report but Pat seemsunaware of the problem and can’t remember thepatient being especially disturbed.Pat feels defensive and hurt because the procedurewas completed successfully and good clinical skillswere used throughout.Path twoYou say to the patient “Of course we’d love to say thatyou will feel no discomfort at all during this procedurebut we find that each patient is different in the level ofsensitivityin their mouth don’t we Pat? Some patients find itcompletely OK while others experience a level ofdiscomfort. Pat will make the procedure as comfortableas possible. If you find yourself getting uncomfortable,just raise your hand and Pat will give you a break.”Pat says “That’s right, I will make it as comfortable aspossible and you only have to raise your hand if youneed a break”.The patient relaxes a bit and the procedure iscompleted successfully.After the patient leaves, you have a short discussionwith Pat about the benefits of good communicationwith patients and the importance of responding to apatient’s concerns in a reassuring way. You affirm Patfor picking up on your cues.The next time a similar situation occurs, you noticethat Pat is making an effort to communicate effectivelywith the patient and you provide further affirmation. Patis still a bit uncomfortable at first but over time, withfurther input from you, starts to develop a much morenatural and comfortable communication style.Path one demonstrates the supervisor’s lack of skills in effectively communicating with the supervisee and isdetrimental to the patient. Providing good patient care should be prioritised over other concerns. The superviseeis not given any guidance on how to improve their communication skills and later written feedback is likely to beexperienced as unhelpful and critical. (See pages 94-95 for suggestions on giving effective feedback.)Path two demonstrates the supervisor’s ability to prioritise patient care while at the same time using the occasionas an opportunity to model an effective response to a patient’s concerns. The supervisor avoids undermining thesupervisee by including the supervisee while talking to the patient. This prompts the supervisee to join in andpractise this response. Directly addressing the issue after the patient has left allows for further reinforcementof the importance of good communication and provides a basis for ongoing opportunities to assist the superviseein developing this skill.90 HETI The Superguide FIRST EDITION

Reflective practiceWhen reflection occurs in supervision, it can bein relation to reflecting on day-to-day clinical practice,triggered by a challenging clinical encounter, orin anticipation of having to manage a complex situation.It is imperative that reflective practice is conductedin a supportive environment to allow individuals tofreely share information that promotes learning.The supervisor should be aware that strong emotionsare sometimes associated with reflection on anexperience. 5 This can be particularly true when reflectingon an adverse event or when the experience tapsinto earlier personal experience (e.g. previous loss orfailure). A non-judgemental, supportive environment isessential for safe and effective reflective practice.This is especially true if the reflection forms part of agroup supervision activity.Examples of how reflective practiceis conducted include:During structured supervision sessions the superviseeprovides the supervisor with an overview of an issueor incident and the supervisor uses questioningto encourage reflection on its meaning (see exampleon the next page).Reflective journal/record keeping is a self-directedactivity, where the supervisee is guided by a templateof key questions to record their experiences, workthrough the issues and reflect on their learning.They can then use this as a tool for discussion withtheir supervisor or to keep as a record of continuingprofessional development.There are many models of reflective practice that can beused in supervision. One such model is Gibbs’ 6 modelof reflection.The supervisor’s toolkit – activitiesModel of reflective practiceDescriptionWhat happened?Action planIf it arose againwhat would you do?FeelingsWhat were youthinking and feeling?The reflective cycleConclusionWhat else couldyou have done?EvaluationWhat wasgood and badabout the experience?AnalysisWhat sense can youmake of the situation?5 Boud et al. cited in Sandars, J. (2009). The use of reflection in medical education: AMEE guide no. 44, Medical Teacher, (31), 685-695.6 Gibbs, G. (1988). Learning by doing: a guide to teaching and learning methods. Further Education Unit, Oxford Brookes University, Oxford.FIRST EDITIONHETI The Superguide91

The supervisor’s toolkit – activitiesCase study: Gibbs’ model of reflectionDescriptionDescribe as a matter of fact what happened during your critical incident or chosen episode forreflectionI was administering anaesthetic to a patient and my hand was shaking so I didn’t end up administeringthe full dose. I didn’t tell the dentist but she realised that the area wasn’t sufficiently numb when thepatient reacted in pain to the drill. The dentist asked me in front of the patient whether I had numbedthe area properly. I had to admit that I hadn’t administered the full dose and the patient becamevery angry.FeelingsWhat were you thinking and feeling at the time?I was concerned about the safety of the patient because I knew I hadn’t done my job properly but Ididn’t know how to let the dentist know what had happened without alarming the patient. I had beenfeeling nervous about giving the injection because I had worked with this patient before and I knew hecould be stressed and difficult.I was embarrassed about how nervous I was so I didn’t let the dentist know because I thought I shouldbe able to deal with this sort of thing easily by now. In the end, I felt the situation was out of control.EvaluationList the points or tell the story about what was good and what was bad about the experienceI am surprised I was able to admit my mistake in front of the patient and deal with his reaction withoutbursting into tears. I would have preferred it if the dentist had asked how much anaesthetic I hadadministered rather than saying “Did you numb it properly?” as I could have let her know that thepatient needed more without causing alarm. I should have been honest about my nerves before westarted the procedure. I feel guilty for not explaining my error straight away instead of saying nothinguntil the problem became obvious.92 HETI The Superguide FIRST EDITION

AnalysisWhat sense can you make out of the situation? What does it mean?I think I have trouble dealing with patients who really stress out about visiting the dentist and I allowtheir stress to become my stress. I should have spoken to the dentist before we got into the roomwhen I realised how I was feeling because in the end it was more embarrassing to make a mistake likethis with a patient than it would have been to admit I was nervous.The supervisor’s toolkit – activitiesAfterwards, I was worried that the dentist would question my professionalism and I feel that thisincident has really affected my self-confidence.ConclusionWhat else could you have done? What should you perhaps not have done?I could have explained to the dentist that I had a bad experience working with this patient beforeand asked for advice on working with highly stressed patients and calming myself down before theprocedure. I shouldn’t have kept silent about my mistake. I should have found a way to communicateto the dentist that the full dose hadn’t been administered before she started drilling.Action planIf it arose again, what would you do differently? How will you adapt your practice in light of this newunderstanding?I think I need to allow myself some time to get grounded before working with anxious patients. I needto research some relaxation and stress management strategies and practise them. It might also behelpful to find out about ways of communicating mistakes in front of patients without alarming them.I recognise that it was important for me to talk the incident through with my supervisor and reflect onall aspects of the situation in order to learn from it.‘Critical reflection requires an ability to conceptualise and analyse, together with willingness to examine the assumptionsunderpinning one’s practice, in order to improve it.’ 7An example of a reflective practice template can be found in the templates section on page 127.7 Napier, L. (2006). Practicing critical reflection, in O’Hara, A & Weber, Z (2006). Skills for human service practice. Working with individuals, groups andcommunities, Oxford University Press, p.7.FIRST EDITIONHETI The Superguide93

The supervisor’s toolkit – activitiesProviding feedbackFeedback is an essential component of supervision and must be clear so that the supervisee is aware of theirstrengths and weaknesses and how they can improve. It is an area of supervisory practice that a lot of supervisorsstruggle with but it is one of the most important parts of the role.“The most important factor in learning is usually the quality of the feedback on performance” 8To give effective feedback:Be timely:Give feedback as close as possible to the event. However, pick a good moment for feedback (not when youor the supervisee is exhausted, distracted or upset). Feedback on performance should be a frequent featureof your relationship with your supervisee.Be in an appropriate setting:Positive feedback can be effective when given in the presence of peers or patients. Negative feedback(constructive criticism) should be given in a private and undisturbed setting.Be specific:Vague or generalised praise or criticism is difficult to act upon. Be specific and the supervisee will knowwhat to do. Adopt a straightforward manner, be clear and give examples where possible.Be constructive:Focus on the positive. Avoid dampening positive feedback by qualifying it with a negative statement(“You did well in choosing the correct intervention for Mrs Smith, but ...”). For constructive criticism, talk interms of what can be improved, rather than what is wrong. Ask the supervisee for a self-assessment of theirperformance. Try to provide feedback in the form of solutions and advice. At the same time, if the superviseemakes an error, feedback needs to be clear.Use active listening:Supervisees should be given the chance to comment on the fairness of feedback and to provide explanationsfor their performance. A feedback session should be a dialogue between two people. 9,10See page 88 for tips on active listening.8 Eraut, M. (2004). A wider perspective on assessment. Medical Education, 38(8), 803-804.9 Cohen, M. (2005). HNET supervisors manual, Hunter New England Area Health Service, Newcastle, (updated 2009).10 Lake, F. & Ryan, G. (2006). Teaching on the run: teaching tips for clinicians, MJA Books, Sydney.94 HETI The Superguide FIRST EDITION

Providing feedbackConsequences of a lack of clear feedbackto underperforming supervisees• Clinical care is not as good as it could be.• Others are blamed when the superviseeis unsuccessful.• Learning is inhibited, career progression is delayed.The supervisor’s toolkit – activities• Anxieties and inadequacies are not addressed.• When weaknesses are exposed later in their career,the supervisee has difficulty accepting criticismbecause of previous “good reports”.• Supervisees are not given the opportunity to developto their full potential. 11Reflective practiceDescribe a time when you had to give important feedback to a supervisee.Considering the guidelines on effective feedback, what do you think you did well?What do you think didn’t go so well?What was the outcome? Was your feedback effective?In what specific ways could you improve your future feedback sessions?11 Cohen, M. (2005). HNET supervisors manual, Hunter New England Area Health Service, Newcastle, (updated 2009).FIRST EDITIONHETI The Superguide95

The supervisor’s toolkit – activitiesProviding feedbackProviding feedback to build diagnostic skillsDuring a supervision session, a supervisee presents a case involving restoration of a grossly cariousmolar tooth. The supervisee gives an opinion that focuses on treatment of the tooth with a root canaltherapy followed by a direct core and final metal ceramic crown restoration. However the superviseehas failed to observe that the tooth in question has a lesion at the furcation and a further radiographhas shown a small communication from the pulp chamber through the furcation.The supervisor affirms the positive aspects of the opinion and then explores the supervisee’sunderstanding of the furcation involvement, thus attempting to elicit the areas to be further explored.When the supervisee fails to recognise the now very poor prognosis for the tooth, the supervisor raisesthis and explains the rationale for the changes to the clinical management plan, i.e. the tooth is nowmarked for extraction. The supervisee is then given an opportunity to reflect on the feedback, discussits relevance in this particular situation and how they will proceed.Providing feedback to an avoidant superviseeYou have noticed over a few supervision sessions that your supervisee, Robert, has been focusingon examinations, scale, and cleans but avoiding restoration work. Robert is very pleasant and eagerto please. Robert has chosen an eight year old boy to work with today and wants to start with anexamination and a clean. You know that the last patient you observed when supervising Robert hadsome decay that was not addressed during the treatment session.What next?96 HETI The Superguide FIRST EDITION

Path oneYou note that Robert is actually quite anxious andyou are cautious about adding to this anxiety.You support Robert in talking through the planfor today and offer encouraging advice for workingwith children in the presence of parents.Robert completes the examination and cleansuccessfully and interacts well with the childand the parent.You affirm Robert for another successful procedureand good communication skills.You casually mention to Robert as you are leavingthat you wouldn’t mind observing some restorationwork next time.You later find out that Robert is now working witha different supervisor and is continuing the samepattern of avoiding restoration work.Path twoYou say to Robert “I have noticed that you haven’ttalked about addressing the caries yet in our sessionstogether and I have only had the opportunity to seeyou carry out check-ups and cleaning. I’d like to workon a plan to develop your skills in restoring cavities.”Using active listening, you elicit from Robert somedetail about the specific difficulties he has in carryingout the restoration work.You emphasise to Robert the importanceof developing as a well-rounded practitioner, eventhough some of the aspects of treatment are moredemanding and can be daunting at first. You alsohighlight the importance of treating all the presentingissues for appropriate patient care.Together with Robert you develop a plan, startingwith less technically demanding restorativeprocedures and then progressing to more difficultprocedures. You guide Robert through this withdiscussion, demonstration and supported practice.The supervisor’s toolkit – activitiesTogether you decide that Robert will havethe opportunity to practise cavity preparation duringtoday’s treatment session and you plan for this.Robert successfully caries out the cavity preparationand, as agreed, you complete the procedure.You affirm Robert’s progress and agree on the nextstep to be taken in developing Robert’s skills inthis area.In path one, while the supervisor has affirmed some positive aspects of the supervisee’s skills, they have failedto give appropriate feedback in a timely and constructive manner about the avoidance of restorative work.Excessive anxiety can often lead to avoidance and this avoidance needs to be challenged if the supervisee isto develop appropriate clinical skills. Casually mentioning the problem at the end of the supervision session,without supporting the supervisee to address the issue in a planned way, is likely to exacerbate the problem andreinforce the supervisee’s avoidant behaviour. This can also have a negative impact on patient care when the moredifficult treatment issues are not addressed.Path two outlines a method of giving direct feedback in a timely, specific, and constructive way.While the supervisee’s anxiety may initially escalate when the issue is directly addressed, the supervisor has outlineda supportive plan for overcoming the hurdle. In the longer term, the supervisee’s anxiety will be reduced when hestarts to deal successfully with more technically demanding clinical procedures.FIRST EDITIONHETI The Superguide97

The supervisor’s toolkit – activitiesSmart goalsEvery supervisee should have an individual learning plan with specific learning objectives detailing what it is they areworking towards. This provides a framework for learning and a reference to reflect upon in subsequent supervisionsessions and (if appropriate) during formal reviews.Learning goals should be documented, discussed with the line manager (where applicable) and retained inthe supervision record. They should be regularly reviewed and updated in line with the acquisition of skills andknowledge as the supervisee develops.Learning goals should be SMART: i.e. they should be Specific, Measurable, Achievable, Relevant and Timely.An example of a SMART goal template can be found in the templates section on page 123.SpecificMeasurableAchievableRelevantTimelyGoal must be well defined, clear and unambiguous• What do you want to accomplish?• Why?• Who will be involved?• Where will it occur?Define a criterion for measuring progress toward the goal• How much?• How many?• How will you know when you have reached your goal?Goal must be achievable• How will your goal be achieved?• What are some of the constraints you may face in trying to achievethis goal?Goal needs to be relevant• How does the goal fit with your immediate and long term plan?• How is it consistent with other goals you have?Goal should be grounded within a timeframe• What can you do in six months from now?• What can you do in six weeks from now?• What can you do today?98 HETI The Superguide FIRST EDITION

Examples of SMART goalsTime and workload managementClinical skillsWithin four weeks I will implement three strategies Within three months I will be able to perform quadrantto improve skills in workload management. These restorations in the permanent dentition by:strategies will be:• accessing and reviewing all available protocols and• making a list each morning of tasks that need toguidelinesbe attended to and identifying the priority of each task• discussing with my supervisor any questions or• ensuring that half an hour each afternoon is scheduled uncertainty about the processin my diary to finalise notes and complete statistics• presenting three case studies to my supervisor/• checking emails twice a day only.senior clinician which demonstrate different classrestorations, materials and clinical procedures in bothPresentation skillsupper and lower quadrantsThe supervisor’s toolkit – activitiesWithin eight weeks I will develop and deliver apresentation to my team members on a complex casewithin my current clinical area. I will achieve this by:• identifying a relevant case• exploring different models of case presentation via theliterature and by seeking advice from senior clinicians• writing the presentation and linking practice to theory• practising the presentation initially with my supervisorto get feedback and develop confidence• delivering the presentation at the next team meetingor in-service.• assisting a senior clinician during quadrantrestorations in the permanent dentition• being observed and assisted if necessary by a seniorclinician while performing quadrant restorations in thepermanent dentition in an upper quadrant• being observed and assisted if necessary by a seniorclinician while performing quadrant restorations in thepermanent dentition in a lower quadrant• being observed by a senior clinician while performingquadrant restorations in the permanent dentition• carrying out both upper and lower quadrantrestorations in the permanent dentition independently.FIRST EDITIONHETI The Superguide99

The supervisor’s toolkit – activitiesProblem solvingIt is common for supervisees to raise problem situations or dilemmas during supervision sessions. These couldbe in relation to clinical skills, patient management issues, career pathways, learning needs, organisational skills,workplace relationships, etc. Rather than the onus being on the supervisor to come up with a solution to theproblem, instead it can useful to present a model to help guide the supervisee in solving the problem independently.It is important to highlight to the supervisee that, while problem solving is an automatic and common practice for allof us, sometimes we can get really stuck on a problem, perhaps because we are already overwhelmed, or becausethe problem seems too complicated and difficult to solve. If this happens, it can be useful to follow a step by stepmodel to help find a solution.A common problem-solving model is the six-step process which involves:1. Identifying and defining the problem2. Brainstorming possible solutions3. Evaluating the possible solutions4. Deciding on a solution5. Implementing the solution6. Evaluating the outcomesThis model is described in more detail on page 108 in the form of a handout that can be given to the supervisee touse as a problem-solving guide.The supervisee should be encouraged to write down the problem and possible solutions to help gain a newperspective on the problem. A template for this is provided on page 125.If the problem is interpersonal conflict, it can be really useful to try to solve the problem on paper with the otherperson. In this way both parties can cooperate to try to find a solution which will change the interpersonal dynamicsthat can prolong conflict.100 HETI The Superguide FIRST EDITION

Fostering interprofessional collaborative practiceLearning interprofessionally, when two or moreSupervision and clinical education that facilitates greaterprofessions learn with, from and about each other awareness of the roles and responsibilities of othersto improve collaboration and the quality of care(doctors, nurses, other oral health staff and patients)can have many benefits to both patients and health and that motivates health professionals to engage andprofessionals. This marks a significant departure from communicate with those from other professions canthe ways in which health care workers are traditionally better prepare health professionals for work in today’seducated and supervised: each discipline training or public health system.learning separately to work separately.Supervisors can consider fostering interprofessionalInterprofessional teaching and supervision can prepare collaborative practice by:health professionals to question taken-for-granted• facilitating an interdisciplinary groupprofessional assumptions and explore differentsupervision sessionprofessional perspectives. It also prepares healthprofessionals for team-based care or interprofessional • inviting relevant disciplines to participate in seminars,collaborative practice (IPCP).workshops, clinical reviews, etc.A growing amount of evidence has emerged outlining • supporting interdisciplinary placement programsthe benefits of IPCP which include:• encouraging supervisees to enquire about the roles• increased staff motivation, well-being and retention; and responsibilities of other professional disciplines.The supervisor’s toolkit – activities• decrease in staff turnover;• increased patient and carer satisfaction;• increased patient safety;• increase in appropriate use of specialistclinical resources;• reductions in patient mortalityand critical incidents; and• increase in access to and coordinationof health services. 1212 World Health Organisation (2010). Framework for action on interprofessional education and collaborative practice, viewed on 3 April 2013, http://whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdfFIRST EDITIONHETI The Superguide101

The administrative supervisor’s toolkit role – activitiesBeyond the basicsInterprofessional collaborative practicecan be of benefit to oral health practitionersas there are areas of common concernwith other health practitioners.For more information on team-based careor interprofessional collaborative practice,visit the HETI website.Here are some further referenceson interprofessional collaborativepractice:Hammick, M., Olckers, L., &Campion-Smith, C. (2009). Learningin interprofessional teams: AMEEGuide no 38. Medical Teacher, 31(1),1-12Polverini, P. (2012). A curriculumfor the new dental practitioner:preparing dentists for a prospectiveoral health care environment.American Journal of Public Health.102 (2), e1-e3.Thistlethwaite, J. (2012).Interprofessional education: a reviewof context, learning and the researchagenda, Medical Education, 46, 58-70.102 HETI The Superguide FIRST EDITION

part sixThe supervisor’stoolkit– handoutsThe supervisor’s toolkit – handouts“Supervisors themselves need to be competent in the skillsto be acquired and in dealing with the complications that may arisefrom using these skills.”Kilminster, S., Cottrell, D., Grant, J. & Jolly, B. (2007). AMEE Guide No. 27:Effective educational and clinical supervision, Medical teacher, 29 (1), p. 4

The supervisor’s toolkit – handoutsDeveloping communication skillsThe art of effective communication is a core skill for all oral health professionals. This is crucial in building rapportwith patients, during diagnosis and treatment, providing education to patients (e.g. about dental hygiene),discussing financial matters or waiting times, communicating with other team members, etc.As an oral health worker, you need to be able to adapt your communication to a range of audiences including thoseof a different age, gender, ethnicity, cultural background, religion, etc.Core components of communicationWhen communicating with patients, consider thefour essential components of communication:1. The sender – That’s you. When you are sendinga message to a patient, try to be confidentand assertive. Consider the impact of your facialexpression, tone of voice and body language.2. The message – Be clear about what you want to say.Adapt your message to suit your audience.3. The context or setting in which the message is sent– e.g. if delivering a message during a procedure areyou sure the patient heard the message accurately?4. The receiver – Consider factors that might affectthe patient’s ability to hear and/or understandthe message.Check for understanding after delivering importantmessages to patients, e.g. ”So can you run throughwhat I just said so that I can make sure I have explainedit properly and I can clear up any misunderstandings?”Active listeningBeing an active listener when working with patientsimproves diagnostic accuracy and patient satisfactionand places you in a better position to deal with patientconcerns and guide them through treatment.Active listening involves focusing on the patient whenthey are speaking to you in order to properly understandwhat they are saying. By listening carefully, you are ableto show you have understood what has been said andthis allows the patient the opportunity to provide moreinformation if necessary.Active listening involves all of the following:• Focusing on key and relational words, e.g. what thepatient is saying is happening to him or her.• Paraphrasing or summarising the key ideas in whatthe patient has said, e.g. “So what you’re saying is….”• Asking for clarification or more information if youare unsure of what they are saying or if you requiremore information e.g. “Can you just tell me a bit moreabout...?” or “Is there anything more?”• Verbal prompts such as “ah ha” or “I see” etc.• Displaying non-verbal behaviour that lets the otherperson know you are paying attention to what they aresaying (see next page).104 HETI The Superguide FIRST EDITION

Non-verbal communicationNon-verbal communication can be just as important as what is actually said. When communicating importantmessages, be aware of the volume and tone of your voice, your physical gestures, and facial expressions.Body language is an important component of communication and can have a big impact on how a messageis received.An open posture, calm voice, and relaxed body language help communicate your message in a non-threateningway and this makes it more likely that the message will be heard and understood.The supervisor’s toolkit – handoutsThe following acronym, can help you remember some key factors in non-verbal communication.S – Face the person squarelyO – Open posture, no crossed arms or fidgetingL – Lean towards the person, not too much but just enough to show interestE – Maintain eye contact, without staringR – Be relaxed and comfortableFIRST EDITIONHETI The Superguide105

The supervisor’s toolkit – handoutsTime managementMany workers feel that there are not enough hoursin the day to complete all that is required of them.However, sometimes there is a lot of time during theday that is not used effectively. Effectively managingyour time means focusing on what is important andtaking responsibility for eliminating or controlling thefactors that waste your time.Sometimes the demands on your time during theworking day may feel as if they are outside of yourcontrol but you may have much more control thanyou think. For example, you can’t control whether ornot the phone rings or whether a demanding colleagueinterrupts you but you can manage your responsesto minimise the impact of interruptions. It is easierto influence things over which you believe you havecontrol than things which you believe are externalto you and outside of your control.Start by thinking about what wastes your time.Think about a typical day at your work. Make a list ofall the things which occupy your day and be as specificas you can.The next step is to try and reduce unproductive time.Unproductive time is the time you spend doing thingswhich do not contribute to the achievement of goals.Ask yourself:1.What can be eliminated?Organise the daily tasks you listed into the followingthree categories:A. What I must doB. What I should doC. What I choose to doSimply write the appropriate letter against each item.The items with a B or C are potentially tasks you caneliminate. Now ask yourself, “For each of these tasks,what would happen if it were not done?” Be ruthless,don’t be emotional, be cold and critical. Many tasksmasquerade as important because of who asksfor them, their deadline, their tradition etc.2. What can be delegated?Delegation is not just simply passing the buck.It involves sharing work and responsibility to developeveryone in the team. The person who says “Yes”to everything is not effective. You should learn to shareresponsibility and then leave it with the personto whom you delegated the task.3. What can be simplified?Some tasks can be simplified by introducing automatedsystems, e.g. through using statistical software,databases, mailing lists and merge documents.You can also consider breaking tasks into smaller partsso that you can more effectively use smaller periodsof available time to work towards task completion.Consider whether your standards are too high andwhether you are just doing it that way becauseof tradition rather than because it is an efficient wayto complete the task.Make a commitment to yourself that “From now onI am going to make better use of my time.”106 HETI The Superguide FIRST EDITION

Smart goalsSpecificGoal must be well defined, clear and unambiguous• What do you want to accomplish?• Why?• Who will be involved?• Where will it occur?The supervisor’s toolkit – handoutsMeasurableAchievableRelevantTimelyDefine a criterion for measuring progress toward the goal• How much?• How many?• How will you know when you have reached your goal?Goal must be achievable• How will your goal be achieved?• What are some of the constraints you may face in trying to achievethis goal?Goal needs to be relevant• How does the goal fit with your immediate and long term plan?• How is it consistent with other goals you have?Goal should be grounded within a timeframe• What can you do in six months from now?• What can you do in six weeks from now?• What can you do today?FIRST EDITIONHETI The Superguide107

The supervisor’s toolkit – handoutsProblem solving modelProblem solving is something we all do automaticallyin our day to day lives. It is usually a matter of identifyinga dilemma, running through some possible solutionsin our minds, evaluating the pros and cons of thedifferent options, and deciding on a course of action.If it doesn’t work, we would probably then trysomething else.However, sometimes we can get really stuck on aproblem, perhaps because we are already overwhelmed,or because the problem seems too complicated anddifficult to solve. If this happens, it can be usefulto follow a step by step model to help find a solution.A common problem-solving model is the six-stepprocess described below.Step 1: Identify and define the problemSelect and define the problem to be analysed.Be as specific as possible. Describe the circumstancessurrounding the problem, when it occurs, the situation,who is affected, etc. (e.g. I need to complete someprofessional development before the end of next monthto meet my CPD requirements but the course I want toattend is only run on Fridays. I have no one to replaceme in the clinic on Fridays which would leave mycolleague overworked.)Step 2: Brainstorm possible solutionsStep 3: Evaluate the possible solutionsRead through your list and cross off any solutions thatare obviously unrealistic or undesirable.Write down the pros and cons of the remainingsuggestions.List the possible solutions in order of preference,considering the pros and cons of each.Step 4: Decide on a solutionChoose which solution you are going to implement.Make a plan of action for implementing this solution.Be as detailed as possible, considering who will beinvolved and when, where, and how the solution willbe implemented, (e.g. Send an email today to mycolleagues and ask if anyone would be available to fillin for me at the clinic on Friday 24th.)Step 5: Implement the solutionFollow through with the plan of action.Step 6: Evaluate the outcomesConsider how effective the solution was in solvingthe problem.If the problem has not been solved or not fully solved,decide whether a new solution needs to be tried.Write down as many possible solutions as you canthink of to solve the problem.Try to be as creative as possible and don’t worry toomuch about whether the solutions are realistic or not.The more creative you are, the more chance you haveof coming up with a workable solution.Try to come up with at least 12 possibilities.Go back to Step 3 and choose an alternative solutionor go back to Step 2 and generate some newpossibilities.Repeat the remaining steps.Writing down the problem and solutions can be auseful strategy to help you get unstuck. You can gain anew perspective on a problem by getting it out of yourhead and onto paper.If the problem is interpersonal conflict, it can be reallyuseful to try to solve the problem on paper with theother person. In this way you join together to tryto find a solution which will change the interpersonaldynamics that can prolong conflict.108 HETI The Superguide FIRST EDITION

Stress managementStress is the “wear and tear” our bodies experienceas we adjust to our continually changing environment.It has physical and emotional effects on us and cancreate positive or negative feelings. In adjustingto different circumstances, stress will help or hinderus depending on how we react to it.The ABC of stress management2. Recognise what you can change.Can you change your stressors by avoidingor eliminating them completely?Can you reduce their intensity (manage them over aperiod of time instead of on a daily or weekly basis)?Can you shorten your exposure to stress(take a break, leave the physical premises)?The supervisor’s toolkit – handoutsAwarenessRecognising your stressors and your own stressreactions.BalanceThe aim is not avoid stress but to find your optimumstress level, with enough stress for motivation andstimulation, but not overload.ControlBy combining awareness and balance, you achieveself-direction and self-responsibility. This can lead to agreater chance of controlling the situation.How can I manage stress better?1. Become aware of your stressors and your emotionaland physical reactions.Notice your distress. Don’t ignore it.Don’t gloss over your problems.Determine why events distress you. What are youtelling yourself about the meaning of these events?Determine how your body responds to the stress.Do you become nervous or physically upset?If so, in what specific ways?Can you devote the time and energy necessaryto making a change? Goal setting and timemanagement techniques might be helpful here.3. Reduce the intensity of your emotionalreactions to stress.The stress reaction is triggered by your perceptionof danger – physical danger and/or emotional danger.Are you viewing your stressors in exaggerated termsand/or taking a difficult situation and makingit a disaster?Are you expecting to please everyone?Are you overreacting and viewing things as absolutelycritical and urgent? Do you feel you must alwaysprevail in every situation?Work at adopting more moderate views. Try to seethe stress as something you can cope with rather thansomething that overpowers you.Try to moderate your excess emotions.Put the situation in perspective. Do not labouron the negative aspects and the “what ifs”.4. Learn to moderate your physical reactions to stress.Slow, deep breathing will bring your heart rateand respiration back to normal.Relaxation techniques can reduce muscle tension.FIRST EDITIONHETI The Superguide109

The supervisor’s toolkit – handouts5. Build your physical reserves.Exercise for cardiovascular fitness three to four timesa week (moderate, prolonged rhythmic exercise isbest, such as walking, swimming, cycling, or jogging).Eat well-balanced, nutritious meals.Maintain your ideal weight.Avoid nicotine, excessive caffeine, and otherstimulants.6. Maintain your emotional reserves.Develop some mutually supportive friendships/relationships.Pursue realistic goals which are meaningful to you.Expect some frustrations, failures, and sorrows.Always be kind and gentle with yourself – treatyourself as you would a good friend.Mix leisure with work. Take breaks and get awaywhen you can.Get enough sleep. Be as consistent with your sleepschedule as possible.For more information on stress management and otherrelated issues, there are some useful resources to befound at Beyond Blue.110 HETI The Superguide FIRST EDITION

part sixThe supervisor’stoolkit– templatesThe supervisor’s toolkit – templates“Supervision takes place in a context and the supervisor usuallyhas a key part to play in creating the best possible environmentfor training.”Kilminster, S., Cottrell, D., Grant, J. & Jolly, B. (2007). AMEE Guide No. 27: Effectiveeducational and clinical supervision, Medical teacher, 29 (1), p. 13

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Supervision contract *This supervision agreement is made between:(Supervisee)and(Supervisor)The supervisor’s toolkit – templatesWe agree to the following:The aim of supervision is to enable the supervisee to reflect in depth on issues affecting practice in order to developprofessionally and personally towards achieving, sustaining and developing a high quality and safe service topatients of(Organisation)We will read, discuss and adopt the agreed organisational policy and guidelines on clinical supervision, ifappropriate.The time and place for supervision meetings will be protected by ensuring privacy, time boundaries, punctuality andno interruptions. Sessions will only be cancelled with good cause and an alternative/next date confirmed.We shall aim to meet regularly as follows:Frequency:Length of session (approx.):Sessions will be guided by an agenda and agreed to by both supervisor and supervisee but will contain timefor ad hoc discussion and reflection where appropriate.The content of supervision will not be discussed outside the session unless expressly agreed by both partieswith the exception of unsafe, unethical or illegal practice being revealed.Signed:(Supervisee)Date:Signed:(Supervisor)Date:Source: Adapted from City & Hackney Teaching Primary Care Trust, Clinical Supervision Policy, CL003, July 2006.* Please note that this contract does not replace a supervised practice plan which may need to be completed for the purpose of gaining registrationas a practitioner.FIRST EDITIONHETI The Superguide113

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Clinical supervision agreementDate of AgreementSuperviseeClinical supervisorTeam leaderThe supervisor’s toolkit – templatesReview date1. Clinical supervision will address the following areas:2. Clinical supervision will take the following form and frequency(eg. 1:1 meeting, team meeting, peer shadowing):3. Confidentiality:Our understanding of confidentiality is that the content of support meetings is confidential between the parties,but where there are issues regarding clinical risk and/or performance management, information may needto be shared with other relevant parties. Should information need to be shared, the supervisor will advise thesupervisee in advance of this occurring, including what information will be shared, with whomand for what purpose.Other areas to consider:4. Record of clinical supervisionWho will record it?Where will the records be kept?Who has access to this information?What will happen to the clinical supervision notes when the supervisee leaves their position?Notes will be maintained/Archived in line with record management policies.FIRST EDITIONHETI The Superguide115

The supervisor’s toolkit – templatesClinical supervision agreementAdditional information:5. Clinical supervision meetings (if applicable)The supervisee will prepare for each meeting by:The clinical supervisor will prepare for each meeting by:Should a meeting need to be rescheduled we agree to:6. Other considerationsThe details of this document can be modified at any time when agreed by both parties. A copy of thisagreement will be given to the team leader/line manager for their records.Signed: ___________________________Date: ___________________________(Supervisee)Signed: ___________________________Date: ___________________________(Supervisor)Source: Port Augusta Hospital and Regional Health Service, cited in Allied Health Clinical Support Framework, Country Health SA, SA Health, May 2009.116 HETI The Superguide FIRST EDITION

Supervision session recordPresent:Apologies:Date:The supervisor’s toolkit – templatesTopic Discussion Agreed ActionAgenda items for next sessionPreparation requiredSigned:(Supervisee)Signed:(Supervisor)Date:Date:Source: Allied Health Clinical Support Framework, Country SA, SA Health, May 2009.FIRST EDITIONHETI The Superguide117

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Supervision logSupervisor:Supervisee:Date Type/Length of session OutcomeThe supervisor’s toolkit – templatesSource: Allied Health Clinical Support Framework, Country SA, SA Health, May 2009FIRST EDITIONHETI The Superguide119

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Supervision feedback formThis form is designed to help you, your team and the service as a whole to get the mostfrom your clinical supervision.Frequency of supervision sessions:The supervisor’s toolkit – templatesDo you have an agreed documented supervision contract with your supervisor?Are your supervision goals and objectives being met?Yes / NoYes / NoIn what way are/aren’t these goals and objectives being met?What are the most useful aspects of your supervision?What expectations are not met from your supervision?Do you have any additional comments about your supervision?Source: Area Nursing and Midwifery Services Policies and Procedures, Clinical Supervision Policy 2007/01 cited in South Eastern Sydney Illawarra areaprocedure, Clinical Supervision – Podiatrists, September 2008.FIRST EDITIONHETI The Superguide121

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SMART goal templateSMART goals need to be Specific, Measurable, Achievable, Relevant and Timely.SMART goal:The supervisor’s toolkit – templatesTarget completion date:Specific steps:SMART goal:Target completion date:Specific steps:FIRST EDITIONHETI The Superguide123

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Problem solving templateStep 1: Define the problem and your goal for resolving it as specifically as possible.Step 2: Brainstorm possible solutions, try to come up with at least 12 options.The supervisor’s toolkit – templatesRead through your list and cross off any solutions that are obviously unrealistic or undesirable.Number the remaining suggestions in order of preference.Step 3: Write down the pros and cons of the top 3 or 4 solutions.Possible solution Pros Cons1.2.3.4.Step 4: Write an action plan for implementing your top solution.Step 5: Implement the planAction plan:Target date:Who else is involved:Steps:Step 6: Evaluate how effective the solution was in solving the problem. If the problem has not been solved or notfully solved, go back to Step 3 and choose an alternative solution or go back to Step 2 and generate some newpossibilities. Repeat the remaining steps.FIRST EDITIONHETI The Superguide125

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Reflective practice templateDescription – Describe as a matter of fact what happened during your critical incident or chosenepisode for reflection.The supervisor’s toolkit – templatesFeelings – What were you thinking and feeling at the time?Evaluation – List the points or tell the story about what was good and what was bad about the experience.Analysis – What sense can you make out of the situation? What does it mean?Conclusion – What else would you have done? What should you perhaps not have done?Action plan – If it arose again, what would you do differently? How will you adapt your practice in lightof this new understanding?Source: Adapted from Gibbs, G. (1988) Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Brookes University,Oxford.FIRST EDITIONHETI The Superguide127

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Agenda template exampleAgenda structure Content Timing(approx.)1. Preparation Supervisors and supervisees must prepare for a clinical supervision session. The supervisee needs to consider what they want Before sessionto focus on – preparing specific questions prior to the session will help focus thinking and reflection.• Review notes on what was discussed in previous clinical supervision session.• Review goals.• Write notes about what to talk about in clinical supervision.• Use support materials such as reflective journal/ portfolio, case notes review, results of measuring outcomes, reflective statements.2. Identifying and exploring • Identify incident or area to focus on and explore/talk over new issues.10 mins• Reflect on issues affecting practice, caseload planning, decision making.• Reflect on patient incidents or interventions.• Review what was discussed at previous clinical supervision session.• Casework review – Presentation of a clinical issue or patient case by the supervisee.3. Analysing • Clarifying, analysing, questioning, challenging actions/ideas and considering options. Discussion and feedback from the30 minssupervisor. The supervisor may use questioning to aid the supervisee’s reflection and encourage them to reach new conclusions.4. Goal setting andaction planningThe supervisor may demonstrate a particular treatment for a given situation or draw attention to a particular guideline or outcome 10 minsmeasure and may suggest further information gathering through reading.Review of issues in conjunction with:• Relevant theories• Practice standards• Quality indicatorsGoal setting – problem solving and action plan to achieve goals. SMART goals (specific, measurable, achievable, realistic, timely).Link the discussion of goals to the last meeting. Assigning new issues to address. Identify short, medium and long-term goals andtime frames to achieve these goals – Tasks are identified to achieve goals.5. Summarising Review the session, record and close. It is essential that an outcomes-based action plan is agreed upon at the end of each session. 10 minsIt is recommended that the supervisee records the learning outcomes and action plan from the session.6. Reflection in practice Apply new information/skills/approaches to clinical practice. Ongoing reflection on practice. Bring to nextsessionSource: Adapted from Clinical Supervision Program and Procedures, Department of Nutrition & Dietetics, Central Hospital Network, South Eastern Sydney Illawarra Area HealthThe supervisor’s toolkit – templatesFIRST EDITIONHETI The Superguide129

The Superguidea guide for oral health professionalsThis is a user friendly guide designed to assistoral health professionals who are responsible forsupervising other staff.It provides information about:•supervising oral health professionals in waysthat contribute to the safety and better careof patients•effective methods of contributing to theeducation, welfare and professionaldevelopment of oral health professionalsThis guide is not a policy document. It gives tipsand suggestions based on the publishedevidence of what makes good supervision andthe knowledge of many experienced oral healthsupervisors in New South Wales.www.heti.nsw.gov.auISBN 978-0-9871936-2-9