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Clinical Supervision, Knowledge Translation and Evidence-Based Practice Commitment to evidence-based practice The implementation of evidence-based approaches is not without controversy among human service practitioners, and has been criticized on the grounds that it privileges empiricism over other dimensions and sources of wisdom, such as qualitative research, practice wisdom, consumer perspectives, cultural considerations and situational context (Petr & Walter, 2005). This perspective, however, doesn’t acknowledge the ways in which our understanding of evidence-based practice has evolved. For example, Petr and Walter discuss how, in the social work field, the rise of empirically based practice in the late 1980s emphasized clinical practice based primarily on scientific expertise. By the mid-1990s this notion broadened to consider the appropriateness of research applications to individual situations, ethical issues, and client values and expectations. Current conceptualizations refer to “evidence-based practice wisdom,” with an appreciation of multiple sources of “evidence” applied in a value-critical approach. It may be necessary for clinical supervisors to discuss clinicians’ understanding of evidence-based practice, and to explore how clinicians apply advances in scientific knowledge and integrate these with other knowledge sources. Supervisor expertise In the supervision context, “expertise” means more than one’s ability to demonstrate advanced proficiency in evidence-based treatment protocols. Supervision requires a deep, critical understanding of the theoretical, research and practice dimensions of these treatment approaches, as well as an ability to deconstruct these approaches into concrete, practical applications. As an analogy, not all outstanding athletes are successful coaches: applying skills is different from teaching and supporting skill development in others. There is a large literature related to adult education and training that is beyond the scope of this handbook. However, Renner (1999) provides a summary of adult learning theory and practice that is concise yet comprehensive. Opportunities for observation and practice Clinical supervisors need to resist the temptation to use clinical supervision time primarily for discussing cases and dispensing advice. Learning by doing, or active learning (based on the learning theory known as constructivism), has become the hallmark of current approaches to teaching and learning (Tight, 1996). Examples of incorporating active learning into supervision might include: 15
Clinical Supervision Handbook • role-playing a challenging case example with the clinician • live observation and feedback of a clinical consultation • practising a discrete skill (such as complex reflections in motivational interventions) with clinicians • playing a video recording of a session with frequent pauses for critical, reflective commentary by the clinician and/or clinical supervisor/group. • In all of the above examples, clinical skills are examined in the context of the evidence-based treatment application being applied or demonstrated. Psychological safety and constructive feedback Demonstrating skills in front of clinical supervisors and peers is often experienced as “high-risk” by clinicians, and demands that clinical supervisors convey collegial respect, positive regard and non-judgmental acceptance. Fostering a positive learning climate can be better accomplished when clinical supervisors model their willingness to take risks and are transparent about the areas they need to further develop. For example, the clinical supervisor could first demonstrate practice activities before asking clinicians to do so. In addition, feedback is generally experienced as more constructive and salient when it is neutral, concrete and references the skills or philosophy underlying the clinical approach. In summary, advancing skills development in evidence-based practice approaches means that clinical supervisors must: • facilitate a shared understanding and appreciation of the meaning of evidencebased practice • be proficient in supporting clinicians to learn evidence-based approaches and apply these approaches to practice • apply and critique concrete strategies and tools in a safe and supportive learning context. 16
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A Pan American Health Organization
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