NSW Clinical Supervision Support Project Mapping Study

Transcription

NSW Clinical Supervision Support Project
Mapping Study
Final Report
August 2012
CONTENTS
ACKNOWLEDGEMENTS .......................................................................................................................... …5
TERMINOLOGY ............................................................................................................................................ 7
EXECUTIVE SUMMARY ............................................................................................................................... 8
1. INTRODUCTION ................................................................................................................................
15
1.1 ABOUT THE HEALTH EDUCATION AND TRAINING INSTITUTE (HETI)………....... 15
1.2 ABOUT HEALTH WORKFORCE AUSTRALIA…………………………………………....15
1.3 NSW CLINICAL SUPERVISION SUPPORT PROJECT………………………………....16
1.4 METHODS AND INFORMATION SOURCES………………………………………….....17
1.5 STRUCTURE OF THE REPORT.................................................................................22
1.6 CAVEATS AND CONSIDERATIONS ..........................................................................22
2. BACKGROUND CONTEXT ...................................................................................................................25
2.1
NSW PUBLIC HEALTH WORKFORCE ....................................................................25
2.2
CLINICAL SUPERVISION MODELS ........................................................................26
3. OVERVIEW OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN NSW ....................27
3.1 OVERVIEW OF SURVEY RESPONSES.....................................................................27
3.2 DEMOGRAPHICS AND LOCATIONS OF CURRENT SUPERVISORS.......................28
3.3
CONTEXT AND CULTURE OF SUPERVISION .......................................................31
4. PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN ALLIED HEALTH ....36
4.1 OVERVIEW OF STUDENT, TRAINEE AND INTERN SUPERVISION IN ALLIED
HEALTH ......................................................................................................................37
4.2 PROFILE OF SUPERVISORS OF ALLIED HEALTH STUDENTS, TRAINEES AND
INTERNS ....................................................................................................................37
4.3 CAPACITY FOR SUPERVISION OF STUDENTS, TRAINEES AND INTERNS IN
ALLIED HEALTH .........................................................................................................48
4.4 CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR ALLIED HEALTH
STUDENTS, TRAINEES AND INTERNS ....................................................................53
4.5 INCREASING SUPERVISORY CAPACITY ..................................................................55
5. PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN DENTISTRY ............56
5.1 OVERVIEW OF STUDENT AND INTERN SUPERVISION IN DENTISTRY…………...57
5.2 PROFILE OF SUPERVISORS OF DENTAL STUDENTS AND INTERNS ...................57
5.3 CAPACITY FOR SUPERVISION OF DENTAL STUDENTS, TRAINEES AND
INTERNS. ...................................................................................................................66
5.4 CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR DENTAL STUDENTS,
TRAINEES AND INTERNS .........................................................................................70
5.5 INCREASING SUPERVISORY CAPACITY ..................................................................72
NSW CSSP Mapping Study
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6. PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN MEDICINE ................73
6.1 OVERVIEW OF MEDICAL STUDENT, TRAINEE AND INTERN SUPERVISION ........74
6.2 PROFILE OF SUPERVISORS OF MEDICAL STUDENTS, TRAINEES AND
INTERNS.......................................................................................................................74
6.3 CAPACITY FOR SUPERVISION OF STUDENTS, TRAINEES AND INTERNS IN
MEDICINE...................................................................................................................84
6.4 CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR MEDICAL STUDENTS,
TRAINEES AND INTERNS .........................................................................................88
6.5 INCREASING SUPERVISORY CAPACITY ................................................................91
7.
PROFILE OF SUPERVISORS OF STUDENTS AND TRAINEES IN MIDWIFERY ............................92
7.1 OVERVIEW OF STUDENT AND TRAINEE SUPERVISION IN MIDWIFERY ..............93
7.2 PROFILE OF SUPERVISORS OF MIDWIFERY STUDENTS AND TRAINEES ..........93
7.3 CAPACITY FOR SUPERVISION OF STUDENTS AND TRAINEES IN Midwifery .....101
7.4 CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR MIDWIFERY
STUDENTS AND TRAINEES ....................................................................................105
7.5
INCREASING SUPERVISORY CAPACITY .............................................................107
8. PROFILE OF SUPERVISORS OF STUDENTS AND TRAINEES IN NURSING ................................108
8.1 OVERVIEW OF Student AND TRAINEE SUPERVISION IN NURSING ....................109
8.2 PROFILE OF SUPERVISORS OF NURSING STUDENTS AND TRAINEES ............109
8.3 CAPACITY FOR SUPERVISION OF STUDENTS AND TRAINEES IN Nursing ........119
8.4 CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR NURSING STUDENTS
AND TRAINEES ........................................................................................................124
8.5
INCREASING SUPERVISORY CAPACITY .............................................................126
9. CONSIDERATIONS FOR A TRAINING STRATEGY FOR SUPERVISORS OF STUDENTS,
TRAINEES AND INTERNS .......................................................................................................................127
9.1 CORE SKILLS OF SUPERVISORS ..........................................................................128
9.2 EXISTING TRAINING PROGRAMS IN CLINICAL SUPERVISION............................132
9.3
FUTURE TRAINING IN CLINICAL SUPERVISION .................................................135
9.4 IMPORTANCE OF CONTEXT FOR CLINICAL SUPERVISION TRAINING PROGRAMS
138
9.5
OTHER ISSUES INFLUENCING CAPACITY .........................................................140
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10. PROFILE OF THE SUPERVISION OF STUDENTS, TRAINEES AND INTERNS IN THE PRIVATE
HEALTH SECTOR ....................................................................................................................................141
10.1 PRIVATE HEALTH SECTOR OVERVIEW ...............................................................142
10.2 PROFILE OF STUDENT, TRAINEE AND INTERN SUPERVISION IN THE PRIVATE
HEALTH SECTOR ....................................................................................................146
10.3 OVERVIEW OF SUPERVISION IN THE PRIVATE HEALTH SECTOR ....................149
10.4 PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN THE
PRIVATE HEALTH SECTOR ....................................................................................156
10.5 CAPACITY FOR SUPERVISION IN THE PRIVAT E SECTOR ................................166
10.6 FINDINGS FROM THE PROFILE OF SUPERVISORS IN THE PRIVATE HEALTH
SECTOR ...................................................................................................................172
11. CONCLUSIONS AND IMPLICATIONS ...............................................................................................175
APPENDIX I: DISCIPLINES INCLUDED IN SCOPE ...............................................................................179
APPENDIX II: NSW CSSP ADVISORY COMMITTEE MEMBERS ..........................................................180
APPENDIX III: ELECTRONIC SURVEY QUESTIONS .............................................................................181
APPENDIX IV: SURVEY INVITATION EMAIL TEXT ................................................................................191
APPENDIX V: GEOGRAPHIC CATEGORISATION OF LHDS ................................................................192
APPENDIX VI: INTERVIEW PARTICIPANTS...........................................................................................193
APPENDIX VII: INTERVIEW SCHEDULE ................................................................................................194
APPENDIX VIII: REVIEW OF EXISTING SUPERVISION TRAINING PROGRAMS................................198
APPENDIX XI: POLICIES AND ACCREDITATION OF SUPERVISORS .................................................209
APPENDIX X: PRIVATE SECTOR PROFILE INTERVIEW SCHEDULE .................................................226
APPENDIX XI: PRIVATE SECTOR PROFILE ELECTRONIC SURVEY ..................................................231
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ACKNOWLEDGEMENTS
The project team and Health Education and Training Institute (HETI) would like to acknowledge
the input of all individuals and organisations who contributed to the NSW Clinical Supervision
Support Project Part A: Mapping study.
HETI acknowledges in particular, the contacts who facilitated data collection in each Local
Health District and organisation, the electronic survey respondents and the interview
participants.
PROJECT ADVISORY COMMITTEE
Committee Member
Position
Directorate
Lyn Biviano
Chair, Allied Health
Allied health
Trish Bradd
Director of Allied Health and Chair of Allied Health
Directors Network
Allied health
Deborah Burke
Nurse Educator, Mental Health
Nursing/mental health
Richard Cheney
Area Manager, Allied Health Services
Allied health
Dr Jane Conway
Conjoint Associate Professor
Nursing and midwifery/
university
Dr Roslyn Crampton
Chair, NSW Prevocational Training Council
Medical
Amanda Culver
R/Education Program Manager
TAFE NSW/VET sector
Dr Jennifer Hardy
Senior Lecturer, Clinical Practice Co-ordinator
Nursing and midwifery
Margaret Martin
Nurse Manager, Leadership and Workplace
Capabilities
Dr Rebecca Nogajski
Staff Specialist - Emergency Physician
Medical
Anthony (Tony)
O'Brien
Senior Clinical Lead Research - Associate
Professor Clinical Nursing
university
Michelle Pitt
Acting Director
Rural/VET sector
Karen Patterson
Head, Practice Development Unit
Megan Smith
Allied health
Dr Tony Skapetis
Head of Emergency Dentistry
Dentistry
Dr William (Bill) Thoo
Staff Specialist Geriatric Medicine
Medical/VET/RACP
Jennifer Wannan
Manager, Training Support Unit for Aboriginal
Mothers
Rural/VET/nursing and
midwifery
Meg Wemyss
Allied Health and Nursing Educator
Allied health
Michael Hannon
Associate Director Statewide Education Policy
NSW Ministry of Health
Christina Harlamb
Senior Policy Officer, Statewide Education Policy
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HETI STAFF
• Dr Gaynor Heading, General Manager
• Christina Harlamb, Senior Policy Officer, Statewide Education Policy, NSW Ministry of
Health
• Arline Dumazel, Project Manager, NSW Clinical Supervision Support Project
• Katie Baird, Program Coordinator, NSW Clinical Supervision Support Project
ZEST HEALTH STRATEGIES STAFF
• Dr Alison Evans, Director
• Katherine Vaughan-Davies, Senior Research Manager
• Jen Treacy, Project Manager
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TERMINOLOGY
A number of terms are used throughout this report that have definitions specific to the
parameters of this project. These definitions are outlined below.
Direct supervision 1
Direct supervision means that a supervisor is present, observes, works with and directs the
student, trainee or intern.
Indirect supervision1
Indirect supervision means that the supervisor is easily contactable, but not directly observing,
the activities of the student, trainee or intern.
Formal training
Formal training is defined as any program or course run by a training institution, such as a
university or TAFE college, for which an individual receives a recognised qualification. Formal
training courses generally require participants to adequately meet assessment criteria in order to
successfully complete the course.
Examples of formal training courses include:
• Master’s degree or doctorate
• Graduate diploma or certificate
• Certificate IV in Workplace Training and Assessment.
Informal training
For the purposes of the electronic survey, informal training was defined as any program or
course run by, and/or within, an LHD or facility. Informal training courses may be developed by
the LHD, a training institution or a third party training firm.
Examples of informal training courses include:
• seminars
• workshops
• lunchtime educational sessions.
1
Health Workforce Australia 2011, National Clinical Supervision Support Framework, Health Workforce Australia: Adelaide
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EXECUTIVE SUMMARY
PURPOSE
Health Education and Training Institute (HETI) has been funded by Health Workforce Australia
(HWA) to deliver the NSW component of the Clinical Supervision Support Project (CSSP). The
aim of the NSW CSSP is to increase patient safety and quality of care through increased clinical
supervision support and capacity.
The NSW CSSP is a two-part project:
• Part A: a mapping study of the current clinical supervision standards in NSW across
medicine, allied health, nursing, midwifery, and dental
• Part B: implementation of a training strategy based upon the findings in Part A.
HETI commissioned ZEST Health Strategies to undertake Part A. This report refers only to Part
A of the project.
Project aims for Part A of the NSW CSSP were to:
• develop a profile of clinical supervision across medicine, nursing, midwifery, dental and
allied health in the NSW public health service, by:
o developing a profile of the clinical supervision workforce by location, skill level and
experience
o identifying clinical supervisor roles and levels of experience
• identify clinical supervision training programs, and any opportunities or shortfalls in these
training programs, by:
o identifying clinical supervisor training programs, and mapping these to clinical
supervisor roles and skills
o identifying accreditation standards, government and employer policies setting
requirements for clinical supervision
o identifying gaps between required and actual supervisory skill levels
• identify training needs and training opportunities for clinical supervisors.
Project deliverables for Part A of the NSW CSSP are:
• a comprehensive profile study of clinical supervisors by location, skill level and experience
• a specific mapping study documenting the clinical supervision training programs available
across the education and training continuum and inclusive of the full range of professions
– medicine, nursing, midwifery, dental and allied health – mapped to supervisor roles and
levels of experience
• identification of the various accreditation standards, government and employer policies
setting requirements for clinical supervision
• identification of gaps between required and actual supervisory skill levels
• identification of training needs and training opportunities
• a succinct report of all findings including an executive summary.
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Project scope was focused on supervision of students, trainees and interns undertaking
education and training in a clinical placement within the following disciplines in the NSW public
health sector:
• allied health
• dental/oral health
• medicine
• midwifery
• nursing.
A complete listing of disciplines included within these definitions is described in Appendix I.
Following completion of the NSW CSSP mapping study in the NSW public health sector, a
project extension was commissioned to further extend the study into the NSW private health
sector.
The purpose of the project extension was to develop a profile of student, trainee and intern
supervision within the private sector, identify any potential capacity for uptake of clinical
supervision within this sector, and the tools and resources required to harness this capacity.
This executive summary reflects findings from the public sector mapping study and the private
sector profiling of supervision.
CAVEATS AND CONSIDERATIONS
• The definition of what constitutes ‘supervision’ varies across and within disciplines.
• Understanding of the terms ‘student’, ‘trainee’ and ‘intern’ are likely to vary across
disciplines.
• Models and approaches to supervision vary between disciplines.
• This mapping study is not a complete audit of people providing supervision across the
health service in NSW; the numbers represent a ‘snapshot’ only.
• The two key methods provide different information: survey data provide a sense of the
prevalence of issues (with caveats) amongst the broader health workforce; interview data
provide greater depth of information about key issues from the perspective of individuals
with an interest and expertise in supervision.
• Feedback about time spent, approaches, number of students supervised and capacity
reflect self-reported information.
• The electronic survey components of the mapping study relied on potential survey
respondents having access to a computer via which to respond to the survey. Lack of
access to a computer, for example by nurses in ward-based settings, may have limited the
response from some disciplines.
• Response rates and representation of survey respondents across disciplines and Local
Health Districts (LHDs) are variable and do not necessarily reflect the breakdown of
disciplines in NSW.
• Survey respondents are more likely to be those with an active interest in supervision, and
therefore, views obtained do not necessarily reflect those of the broader health workforce.
• The concept of ‘supervision’ is a complex one; perspectives and issues for supervisors
were sometimes difficult to separate out from those for students.
• Statistical comparisons between discipline groups have not been calculated and may not
be appropriate given that a random sampling approach was not taken.
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• The qualitative information obtained through interviews is context dependent. It is
recognised that not all contexts in which supervision for students, trainees and interns is
provided were represented and, in most cases, perspectives for each context were
provided by one or two individuals.
• A variety of factors impact on capacity for supervision. The focus of the current project was
training for supervisors, but results should not be viewed in isolation of other relevant
factors.
• It is not appropriate to compare responses across disciplines given the considerable
differences in how supervision is provided.
KEY FINDINGS, CONCLUSIONS AND IMPLICATIONS
The provision of supervision does not differ between the public and private health
sectors
• Findings from separate profiles developed of supervisors in the public and private health
sector show that the skills, experience and approach to supervision between these groups
is comparable.
Key implication
Strategies developed to enhance the capacity of supervisors in the public health sector would be
applicable and well-received by supervisors in the private health sector.
Supervisors were identified across all LHDs in NSW
• The electronic survey identified 1746 people who indicated they have provided supervision
to students, trainees and interns in NSW in the past 12 months.
• Of these, the majority of current supervisors identified as working in allied health (47.3%),
nursing (26.9%) or medicine (20.8%).
• Supervisors of students, trainees and interns were identified in all LHDs and Specialist
Health Networks in NSW.
• The most common setting for supervision of students, trainees and interns in the public
health sector is hospital/ward-based settings (42.6% of respondents).
• Just under one-quarter of public health sector supervisors (23.1%) identified as also
working within a private setting.
• Supervision in the private health sector occurs in hospital/ward-based settings, communitybased settings and private practice.
Key implication
Strategies developed to increase capacity for supervision of students, trainees and interns
should focus on those providing direct supervision in the workplace.
Provision of supervision is context specific
• Although direct supervision was identified as the most common approach to supervision of
students, trainees and interns across all disciplines, the context in which supervision is
provided appears to vary.
• Requirements for supervisors and students can differ in regional and rural placements,
Specialty Health Service settings (such as Justice and Forensic Mental Health).
• Community organisations or private practice settings may also require additional
consideration of business management and profitability prior to providing supervision.
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Key implication
Consideration of the context in which supervision will be important when determining strategies
to increase capacity for supervision. Contextual differences may also limit comparisons of
provision of supervision across different disciplines and service settings in NSW.
The expectation that ‘everyone provides supervision’ may undervalue the supervisory
role
• Three quarters of people identifying as providing supervision in the public health sector
indicated this is a recognised part of their role.
• Three quarters of people identifying as providing supervision in the private health sector
indicated this is a recognised part of their role.
• Interviews with key informants from public and private health sectors suggest ‘education’ is
part of the role description for the majority of people working in health, but that supervision,
and specifically, supervision of students, trainees and interns, is rarely a direct role
requirement.
• In the public health sector mapping study, there was considerable variation between
disciplines in relation to whether supervision roles are funded, the proportion of the role
funded to provide supervision, and the level of awareness of whether supervision roles
were funded.
• This has the potential to undervalue the role of supervisors and results in less focus being
given to strategies to up-skill staff in this role.
Key implication
There is a need to change the culture of supervision such that greater value is placed on the role
of supervisors.
Other factors are important influencers of capacity for supervision
• The main factor impacting on capacity for supervision by both current supervisors and noncurrent supervisors is the difficulty in finding a balance between service delivery and
teaching.
Key implication
Up-skilling supervisors in how to provide supervision in a way that minimises impact on daily
practice may be beneficial.
There is capacity for more supervision within the NSW health workforce, both public and
private sectors
• While many health professionals feel that they are at or beyond capacity with respect to
student, trainee and intern supervision, there appears to be some capacity within the NSW
health workforce for more supervision.
• This capacity comes both from some individuals who are currently providing supervision,
and individuals who are not currently providing supervision but interested in doing so.
• In the public health sector, additional capacity for supervision also may be achieved
through recognition of interdisciplinary supervision.
• In the private health sector, additional capacity for supervision may also be achieved
through assistance in managing the relationship between educational institutions and
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private health facilities. In addition, consideration of private sector business down time
when scheduling supervision may also be beneficial.
Key implication
Consideration of strategies to promote the role of supervisor to people not currently acting in this
role may be beneficial.
Consideration of strategies to address capacity-limiting factors for the uptake of supervision
within the private health sector at a facility level may be beneficial.
Perception of the required core skills for supervision differs between those providing
supervision and those overseeing the provision of supervision
• Survey respondents from across the disciplines in the public and private health sectors
nominated ‘clinical skills and knowledge’ as the most important core skill for supervisors of
students, trainees and interns.
• Interview respondents from the public health sector highlighted the importance of skills in
adult learning, communication and critical review and reflection.
• Interview participants from the public health sector typically highlighted gaps in supervision
and adult education skills (rather than clinical skills) for supervisors of students, trainees
and interns.
• This difference may be explained by the fact that survey respondents were individuals
identifying as providing supervision to students, trainees and interns, whereas interview
respondents were generally higher-level health service employees involved in the
oversight of clinical placements or supervisors.
Key implication
The greater emphasis placed by survey respondents on clinical skills and knowledge as a core
skill for supervisors compared with direct supervisory skills (such as adult learning principles or
remediation of underperforming students) suggests that current supervisors may not recognise
the need for up-skilling in these areas.
There are gaps in required and actual supervisory skill levels
• Interview participants identified skill gaps for supervisors in areas of adult teaching and
learning, critical review and reflection, and understanding the roles and responsibilities of
the student and the supervisor.
• Survey respondents from the private health sector identified gaps for supervisors in
remediation of underperforming students.
Key implication
Feedback suggests a need to up-skill the health workforce in generic supervisory skills, such as
adult learning principles and methods of providing supervision and feedback, both at the point of
patient care, and in a critically reflective setting.
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While there is interest in undertaking training in clinical supervision, training was not
identified as a major factor affecting capacity to provide supervision
• The mapping study identified a level of interest among supervisors to participate in training
programs to increase capacity to take on supervision. The preference is for informal, faceto-face supervision programs. Despite this interest, access to training was not identified as
a major factor impacting on the capacity to undertake supervision.
Key implication
While training in supervisory skills may be beneficial across the disciplines, other strategies
should be considered to improve capacity for supervision.
A ‘one size fits all’ training strategy is unlikely to be effective
• Survey feedback suggests there is interest among current supervisors in undertaking
training in supervision, with more interest in informal training such as LHD-based seminars
than formal training courses.
• Survey and interview feedback suggests that training for supervisors of students, trainees
and interns should incorporate face-to-face components, such as seminars/workshops.
• Survey feedback suggests case study or scenario-based learning is preferred.
• A network of support for supervisors may be useful, to enable supervisors to learn from
each other’s experiences.
Key implication
If developed, a training strategy for supervisors of students, trainees and interns should be
context-specific and incorporate face-to-face and networking components.
Approaches to increase capacity for student, trainee and intern supervision should not
be considered in isolation of broader issues of clinical supervision
• Feedback highlighted the fact that supervision of students, trainees and interns is one
component of a continuum of supervision that continues beyond the PGY1 year.
Key implication
Strategies to increase capacity for student, trainee and intern supervision may carry more weight
if broadened to incorporate clinical supervision at the broader level.
Increased governance and evaluation are likely to be important factors in supervision
• A document search strategy found:
o few policies outlining detailed requirements of the supervisory role of student
supervisors
o a greater emphasis on supervision of existing staff and postgraduate students,
compared with supervision of students, interns and trainees
o no specific accreditation requirements for supervisors of students, interns and trainees,
with the exception of psychologists.
• Interviews suggested there appears to be little governance that formalises the skills
required for supervisors of students, trainees and interns.
• There appears to be little evaluation or monitoring of people in supervisory roles.
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Key implication
Increased governance and evaluation of supervisory roles may help to highlight the importance
of supervision, provide greater impetus to up-skill supervisors and provide ongoing feedback
about areas for future development.
NEXT STEPS
This mapping study set out to develop a profile of supervision of students, trainees and interns
across allied health, dentistry, medicine, midwifery and nursing in the NSW public and private
health sectors. The findings from this mapping study will be used to inform approaches to
increase capacity for supervision of students, trainees and interns. This will involve consideration
of the findings from this study and their implications by relevant experts in clinical supervision
within the NSW health sector.
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1.
INTRODUCTION
1.1 ABOUT THE HEALTH EDUCATION AND TRAINING INSTITUTE (HETI)
The Clinical Education and Training Institute (CETI) was established on 1 July 2010 as a
Statutory Health Corporation, as recommended by the Garling Inquiry into acute care services in
NSW public hospitals. 2
An outcome of the Director-General’s governance review on the future directions for NSW
Health completed in October 2011 saw CETI restructured to become the Health Education and
Training Institute (HETI).
HETI has leadership responsibility for the education and training of clinicians and clinical support
staff in the NSW Ministry of Health. In addition, HETI seeks to build health workforce teaching,
training, leadership and supervision capacity through a focus on undergraduate and vocational
training.
HETI works closely with Local Health Districts (LHDs) and other public health organisations and
clinical training providers to develop and deliver clinical education and training across the NSW
public health system. Many institutions – universities, professional colleges, public and private
hospitals, state and federal government bodies – are involved in training doctors, nurses and
allied health professionals. HETI aims to coordinate, connect and complete the training of NSW
clinicians, to help create effective clinical teams, and to uphold a high standard of patient care
throughout the health system in NSW.
HETI’s Chief Executive is supported by an Advisory Council, which provides strategic advice on
clinical education and training.
1.2 ABOUT HEALTH WORKFORCE AUSTRALIA
Health Workforce Australia (HWA) is an initiative of the Council of Australian Governments
(COAG). It was established to meet the future challenges of providing a health workforce that
responds to the needs of the Australian community.
HWA develops policy and delivers programs across four main areas: workforce planning; policy
and research; clinical education; innovation and reform of the health workforce; and the
recruitment and retention of international health professionals.
A key project for HWA is the Clinical Supervision Support Program (CSSP). The CSSP is a
$28 million national program funded under the National Partnership Agreement on Hospital and
Health Workforce Reform. The aim of this project is to expand clinical supervision capacity and
competence across the educational and training continuum, inclusive of the Vocational
Education and Training (VET) sector, professional entry to postgraduate students and vocational
trainees, for medicine, nursing and midwifery, dental and allied health professions by supporting
measures:
• to prepare and train clinical supervisors
• to deliver and develop a competent clinical supervision workforce, which delivers quality
training.
2
Garling, P (SC) Final Report of the Special Commission of Inquiry: Acute Care in NSW Public Hospitals, 2008 – Overview. Available
at: http://www.lawlink.nsw.gov.au/Lawlink/Corporate/ll_corporate.nsf/vwFiles/E_Overview.pdf/$file/E_Overview.pdf. Published 27
November 2008
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1.3 NSW CLINICAL SUPERVISION SUPPORT PROJECT
1.3.1 Project overview
HETI has been funded by HWA to deliver the NSW component of the CSSP. The aim of the
NSW CSSP is to increase patient safety and quality of care through increased clinical
supervision support and capacity.
The NSW CSSP is a two-part project:
• Part A: a mapping study of the current clinical supervision standards in NSW across
medicine, allied health, nursing, midwifery, and dental
• Part B: implementation of a training strategy based upon the findings in Part A.
HETI commissioned ZEST Health Strategies to undertake Part A. This report refers only to Part
A of the project.
1.3.2 Aims and deliverables
Project aims for Part A of the NSW CSSP were to:
• develop a profile of clinical supervision across medicine, nursing, midwifery, dental and
allied health in the NSW public health service, by:
o developing a profile of the clinical supervision workforce by location, skill level and
experience
o identifying clinical supervisor roles and levels of experience
• identify clinical supervision training programs, and any opportunities or shortfalls in these
training programs, by:
o identifying clinical supervisor training programs, and mapping these to clinical
supervisor roles and skills
o identifying accreditation standards, government and employer policies setting
requirements for clinical supervision
o identifying gaps between required and actual supervisory skill levels
• identify training needs and training opportunities for clinical supervisors.
Project deliverables for Part A of the NSW CSSP are:
• a comprehensive profile study of clinical supervisors by location, skill level and experience
• a specific mapping study documenting the clinical supervision training programs available
across the education and training continuum and inclusive of the full range of professions
– medicine, nursing, midwifery, dental and allied health – mapped to supervisor roles and
• identification of the various accreditation standards, government and employer policies
setting requirements for clinical supervision
• identification of gaps between required and actual supervisory skill levels
• identification of training needs and training opportunities
• a succinct report of all findings including an executive summary.
16
1.3.3 Project parameters
The project focused on supervision of students, trainees and interns undertaking education and
training in a clinical placement within the following disciplines in the NSW health sector:
• allied health
• medicine
• midwifery
• nursing.
A complete listing of disciplines included within these definitions is described in Appendix I. The
project targeted supervisors in the public sector but also captured some private sector
experiences.
Key definitions used for the purposes of the project are outlined in Table 1.1.
Table 1.1: Key definitions used in Part A of the NSW CSSP
Key concept/word
Project definition
Supervision
The oversight of professional procedures and/or processes performed in the
clinical workplace, provided for the purpose of guiding, providing feedback on,
and assessing the personal, professional and educational development of
Existing differences in terminology and definitions between disciplines are
recognised.
Students, trainees
and interns
Includes:
Supervisor
1.4
•
students currently undertaking study through a university or VET college
AND
•
students who have graduated, but are required to complete a set amount
of work experience (years, hours) in order to attain registration
OR
•
students who have graduated and are provisionally registered (e.g.
medical graduates in their PGY1 year, who are provisionally registered).
An appropriately qualified and recognised professional, who guides student,
trainee or intern education and training during clinical placements.
METHODS AND INFORMATION SOURCES
1.4.1 Overview
This report contains information obtained from the following sources, using the following
methods:
• input from the Project Advisory Committee members, established by HETI to provide
advice to the project
• targeted internet and document-based research
• electronic survey of supervisors across NSW of interns, students and trainees, as defined
within the project parameters
• semi-structured telephone interviews conducted with key informants.
An overview of the extent to which the key project deliverables were addressed by each method
is provided in Table 1.2.
17
Table 1.2: Project deliverables mapped to methods
Methodology
Project
aim/deliverable
Project
Advisory
Committee
consultation
Profile study of
clinical supervisors by location, skill
level, roles and
experience
Specific mapping of
the clinical
supervision training
programs available
across the education
and training
continuum
Internet/
documentbased
research
Identification of gaps
between required
and actual
supervisory skill
levels
Identification of
training needs and
training opportunities
Key
informant
interviews
Additional detail
Primarily informed
by survey
X
X
XXX
XXX
Clinical supervision
training programs
mapped to
supervisor roles and
Identification of the
various accreditation
standards,
government and
employer policies
setting requirements
for clinical
supervision
Mapping
survey
X
XX
X
XX
X
XX
X
XX
Focus on
identification of
training programs
available
Focus on links
between training
programs and
clinical supervisor
profile
Supplement
publicly available
information with
interviews with
LHD contacts
Participants views
on key gaps
X
X
X
X
X
X
XX
XX
Survey
participants
identify needs at
broad level; key
informants in
detail
1.4.2 Project Advisory Committee
A 16-member advisory committee, chaired by Dr Roslyn Crampton, was established to provide
advice on this project. The members, listed in Appendix II, are high-level clinical supervision
experts from across NSW.
The Project Advisory Committee provided advice on the project parameters and methods,
particularly the electronic survey, with follow-up advice provided via telephone and email. Nine
Project Advisory Committee members provided additional input through involvement in key
informant interviews.
18
1.4.3 NSW-wide electronic survey
Survey development and dissemination
The survey questions and dissemination approach were developed to meet the project
deliverables, in consultation with HETI and the Project Advisory Committee. Project Advisory
Committee members provided input during the February meeting and via email, helping to
ensure relevance and meaning of survey questions for the target audience. ZEST Health
Strategies, HETI and the Project Advisory Committee Chair worked together to incorporate
feedback and finalise the survey.
The survey was pilot tested, both internally by the project team and externally by HETInominated clinicians. Twenty-four respondents completed the survey during the pilot testing
phase. The test group were asked to review all questions for sense and clinical relevance, and
to check how long the survey took to complete. Minor adjustments were made to the survey
based on feedback from the test group.
The final survey had two primary response pathways, determined by whether or not the
respondent reported having provided supervision to students, trainees and interns within the
past 12 months to students. Those who had provided supervision were guided through Path A to
ask details about the supervision experience, while those who had not provided such
supervision were taken to a much shorter Path B.
The survey was programmed into Survey Monkey, an online survey tool. A copy of the survey is
provided in Appendix III.
The invitation to complete the survey was disseminated by a cascading strategy organised by
HETI. An email with an invitation to complete the survey and survey link was forwarded to HETI
staff, who forwarded the link to a pre-determined list of contacts. This pre-determined list of
contacts was compiled by HETI (CETI at the time) following written correspondence with LHD
Chief Executives, Universities, TAFEs, and other VET sector organisations, professional bodies,
Royal Colleges and other peak bodies. HETI wrote to these organisations to introduce the NSW
CSSP work and team, and to ask for most appropriate contacts to involve in the mapping study.
The invitation to complete the electronic survey was forwarded to these nominated contacts, as
well as to Chief Executives, Deans and Heads of Schools when a specific contact was not
nominated. In addition, the HETI project team distributed the invitation to complete the survey
through the NSW CSSP Advisory Committee, and contacts within HETI networks and on mailing
lists for distribution among their own networks.
This final stage of dissemination was locally determined. Some LHDs chose to distribute the
email to all employees, while others sought to target student supervisors specifically. The total
number of recipients of the survey invitation is unknown. A copy of the invitation email is
provided in Appendix IV.
The online survey was active for completion for a two-week period, 21 March–5 April 2012
(inclusive). One week after the initial invitation, a reminder email was disseminated via the
original cascading communication channel. Project Advisory Committee members agreed to
promote completion of the survey amongst their networks.
Survey responses
In total, 2431 responses were received to the survey. Responses missing key data were
excluded, leaving a total of 2276 valid responses. The filtering process and number of survey
responses by response path is described in Table 1.3.
Responses were received from student supervisors in all core discipline areas, including
medicine, nursing, midwifery, allied health and dental health. Respondents were spread across
all LHDs and Specialist Health Networks.
19
An overall summary of demographic data for respondents is provided in Section 3 and detail by
discipline is provided in Sections 4–8.
Table 1.3: Process to filter valid survey responses
Response path
Total
received
Filter process
Valid
responses
Path A
(currently, recently provide
supervision for students,
trainees and interns)
1837
Exclude 91 responses missing key data
including:
1746
• discipline
AND
• student discipline
AND
• demographic data
Includes one response that provided
student discipline but no additional data
Path B
(do not currently/recently
provide supervision for
students, trainees and
interns)
594
Paths A and B
(combined total)
2431
Exclude 64 responses missing key data
including:
530
• discipline
AND
• demographic data
Includes one administrator’s response
with very little additional data
2276
Survey data analysis
Survey responses were downloaded from Survey Monkey into Excel for filtering, before being
analysed using SPSS software. Primary demographics used for analysis were discipline and
health service location.
Due the small numbers of responses in these disciplines, responses for sonography,
paramedic/ambulance and medical laboratory science were included with those for allied health
for the purposes of analysis. Responses for Aboriginal health were also analysed with other
disciplines, determined by the additional information provided by the respondent. Where no
additional information was available about the discipline, Aboriginal health responses were
included with allied health analysis. Table 1.4 outlines the disciplines used for most analyses.
Health service location was coded as either metropolitan or rural and regional, using the
geographic categories of LHDs (see Appendix V).
1.4.4 Key informant interviews
Interview schedule and approach
Semi-structured telephone interviews were conducted with key stakeholders to provide in-depth
information to complement data obtained through the electronic survey. Interview questions
focused on:
• understanding how student supervision works within the interviewee’s context
• accreditation, policies and guidelines for student supervision
• identifying any gaps in student supervisor skills
• identifying priorities for a student supervisor training program.
20
The interview schedules were developed in collaboration with HETI and are included in
Appendix VI.
HETI identified 30 key informants to be invited to take part in interviews. These key contacts
were identified following written correspondence with Chief Executive Officers of LHDs and
training institutions. In addition, contacts were identified from HETI’s networks of known
contacts, the NSW CSSP Advisory Committee members and emails from people expressing
interest received at HETI following the electronic survey. Representation of the following was
considered in selecting potential interview participants:
• LHD/specialty areas (18 LHDs in total)
• discipline (medicine, nursing, midwifery, dental and allied health)
• training institution (e.g. University, TAFE and private colleges).
Of the 30 identified key informants, 15 took part in interviews, four declined and a further 11 did
not respond after three reminder invitations. A further nine key informants were identified by
HETI and other interview invitees, of whom seven took part. The interviews mostly took
approximately 30 minutes and ranged in length from 15 to 45 minutes.
Interview participants
A total of 22 participants took part in 21 interviews. Each of the core discipline areas, LHDs and
training institute types were represented by the mix of interview participants.
• A total of 12 interview participants were able to speak with some knowledge on
supervision of students, trainees and interns within their LHD. Of these, eight
participants represented metropolitan LHDs, three represented rural or regional LHDs
and one represented a Specialist Health Network.
• A total of 15 interview participants were able to speak with some knowledge on
supervision of students, trainees and interns within the context of their discipline.
Of these, three participants represented allied health, one participant represented
dentistry, four participants represented medicine, one participant represented midwifery
and six participants represented nursing.
• A total of six interview participants were able to speak with some knowledge on
supervision of students, trainees and interns from the perspective of the student
and/or the supervisor’s training institution. Of these, two represented the university
sector, two represented TAFE or other VET institutions and two represented professional
colleges.
Other participants interviewed represented paramedicine (n=2) and the administration of
supervision within LHDs (n=2).
Many interview participants were representative of multiple locations and contexts. Further detail
of interview participants’ location and discipline context is provided in Appendix VII.
Interview data analysis
With the interviewee’s permission, all interviews were recorded and transcribed. Transcripts
were coded and analysed using NVIVO9 software.
1.4.5 Document research
Document research was undertaken primarily to identify:
• clinical supervision training programs available across the education and training
continuum
• various accreditation standards, government and employer policies setting requirements
for clinical supervision.
21
The Clinical Supervision Support Project Environmental Scan and Research Report, produced
by John Ramsey & Associates, details identified national available clinical supervision training
programs. HETI had also compiled a list of clinical supervision training programs. These two
sources of information were supplemented with web-based searches and the interviews. A list of
education courses identified is provided in Appendix VIII.
Two main document research strategies were undertaken to identify accreditation standards,
government and employer policies in addition to those identified through interviews. These
include:
• a review of each relevant professional organisation’s website (for organisations
representing all disciplines identified as within the survey scope) to identify accreditation
requirements for supervisors of students
• a search of the NSW Ministry of Health Policy Directives and Guidelines using the term
‘supervision’, which yielded 172 results, the majority of which were not relevant for
student supervision.
A list of accreditation standards and policies is provided in Appendix IX of this report.
1.5
STRUCTURE OF THE REPORT
This report provides a summary of the findings from the electronic survey and interviews, as well
as information gained through document research. Information has been divided into the
following sections:
• Section 2 provides some background context about the health workforce in NSW
• Section 3 provides an overview profile of the identified supervisors of students, trainees
and interns
• Sections 4–8 provide a detailed description of supervisors and potential supervisors of
students, trainees and interns by main discipline group (allied health, dentistry, medicine,
midwifery and nursing); this includes a profile of supervisors as well as information about
capacity and views on core skills for supervisors
• Section 9 brings together information about identified gaps in skills for supervisors of
students, trainees and interns, preferences for training programs, and barriers to
accessing training that may be useful to inform a training strategy to increase capacity for
supervision of students, trainees and interns
• Section 10 provides a profile of supervisors and supervision practices in the NSW private
health sector.
• Section 11 draws conclusions from the data presented in the report, highlighting
implications of the key findings for consideration by experts in the field of clinical
supervision
1.6
CAVEATS AND CONSIDERATIONS
Review of the findings from this mapping study should take account of the caveats and
considerations listed below.
1.6.1 Terminology considerations
• The definition of what constitutes ‘supervision’ varies across and within disciplines.
• Understanding of the terms ‘student’, ‘trainee’ and ‘intern’ are likely to vary across
disciplines.
• Survey responses indicate that some respondents understood ‘student supervision’ to
include ‘clinical supervision’ of post-registration staff or students, despite the definitions
provided.
22
• Models and approaches to supervision vary between disciplines.
1.6.2 Methodological considerations
• The two key methods provide different types of information from different respondents:
o survey data provide a sense of the prevalence of issues (albeit with caveats outlined)
amongst the broader health workforce but without an opportunity to check how
questions are understood and interpreted
o interview data provide greater depth of information about key issues from the
perspective of individuals with an interest and expertise in supervision, but without a
sense of the prevalence of these issues.
• Both survey and interview data about time spent, approaches, number of students
supervised and capacity reflect self-reported information.
Electronic survey – approach
The electronic survey provided collated data from a large number of health care professionals
across the public health sector in NSW, providing broad range of perspectives and a sense of
the prevalence of some issues. However, consideration should be given to the following caveats:
• there was no opportunity to check individual respondents’ understanding/interpretation of
the questions
• the survey relied on individuals having access to a computer; lack of access to a computer,
for example by nurses in ward-based settings, may have limited the response from some
disciplines
• individuals with an active interest in supervision were more likely to respond to the survey,
and therefore views obtained do not necessarily reflect those of the broader health
workforce.
Key informant interviews – approach
The key informant interviews provided contextual information from people with an interest and
expertise in supervision across the disciplines, in a range of contexts. These individuals held a
range of roles, including managerial roles and positions on professional boards. Thus, most
interview participants were able to provide a perspective that was broader than their own direct
experience. However, consideration should be given to the following:
• information about each discipline or context was provided by one or two respondents only
• interview responses do not provide information about the prevalence of issues identified.
1.6.3 Considerations for data interpretation and reporting
Interpretation of responses to the electronic survey and key informant interviews should take
account of the caveats identified below.
• The mapping study is not a complete audit of people providing supervision across the
health service in NSW; the numbers provided from the electronic survey represent a
‘snapshot’ only.
• Many of the electronic survey questions were not mandatory for respondents and some
questions allowed respondents to select more than one answer. Therefore, the number
of valid responses varies and is clarified where required throughout this report.
• Response rates and representation of electronic survey respondents across disciplines
and LHDs are variable and do not necessarily reflect the breakdown of disciplines within
the NSW public health workforce. Some disciplines may be over- or under-represented
for a number of reasons that could include differences in: access to the survey; number
23
of supervisors; approaches to supervision; interest, availability and incentives for
completing the survey.
• Statistical comparisons of electronic survey results between discipline groups have not
been calculated and may not be appropriate given that a random sampling approach was
not taken.
• The qualitative information obtained through interviews is context dependent. It is
recognised that not all contexts in which supervision for students, trainees and interns is
provided were represented and, in most cases, perspectives for each context were
provided by one or two individuals.
• The concept of supervision is a complex one; perspectives and issues for supervisors
were sometimes difficult to separate out from those for students.
• A variety of factors impact on capacity for supervision. The purpose of the current project
was to inform a training program for supervisors, but results should not be viewed in
isolation of other relevant factors that affect capacity for supervision.
• It is not appropriate to compare responses across disciplines given the considerable
differences in how supervision is provided.
24
2.
BACKGROUND CONTEXT
2.1 NSW PUBLIC HEALTH WORKFORCE
The NSW Ministry of Health employs over 100,000 people across the public health system 3,
making it one of Australia’s largest employers. The health workforce consists of clinical and nonclinical staff across a broad range of disciplines and support areas, including:
• allied health
• dentistry
• medicine
• midwifery
• nursing
• diagnostic staff
• administrative and clerical staff
• domestic and other staff.
The public health workforce in NSW is employed in over 220 public hospitals, 500 community,
family and children's health centres, 220 ambulance stations, and an extensive range of other
services including mental health, dental, allied health, public health, Aboriginal health and
multicultural health services. 4
A review of Australian public hospital statistics, conducted by the Australian Institute of Health
and Welfare, indicated that in 2010–11, 5 nurses constituted over 48% of the health workforce
employed in public hospitals in NSW. A numerical breakdown of full-time public hospital
employees in NSW is provided in Table 2.1.
Table 2.1: Numerical breakdown of the health workforce employed at public hospitals in NSW,
2010–11
Full-time staff members
n
%
Salaried medical officers
9,418
12.1
Nurses
37,451
48.2
Diagnostic and allied health
professionals
11,010
14.2
Administrative and clerical
11,596
14.9
Domestic and other staff
8,250
10.6
Total
77,724
100
The health workforce is spread across 15 Local Health Districts (LHDs) (see Appendix V). Eight
LHDs cover the Sydney metropolitan region and seven cover rural and regional NSW. In
addition, two Specialist Health Networks exist that focus on Children's and Paediatric Services
and Forensic Mental Health. A third Specialist Health Network covers the public health services
provided by three Sydney facilities operated by St Vincent's Health (St Vincent's Hospital and
the Sacred Heart Hospice at Darlinghurst, and St Joseph’s at Auburn).
3
Health Professionals Workforce Plan Taskforce Discussion Paper, NSW Ministry of Health, October 2011.
AIHW 2012. Australian hospital statistics 2010-11. Health services series no. 43. Cat. no. HSE 117. Canberra: AIHW.
5
AIHW 2012. Australian hospital statistics 2010-11. Health services series no. 43. Cat. no. HSE 117. Canberra: AIHW.
4
25
A number of institutions throughout NSW offer healthcare education and training courses to
undergraduate students, trainees and interns. Universities, TAFE and Vocational Education and
Training (VET) colleges offer undergraduate and postgraduate courses across the healthcare
continuum.
Professional Colleges, such as the Royal Australian College of General Practitioners and the
College of Nursing, offer clinical specialty training and professional development to their
postgraduate members.
2.2 CLINICAL SUPERVISION MODELS
The Clinical Supervision Support Project – Environmental scan and research report conducted
by John Ramsey and Associates identified common models of clinical supervision in Australia. 6
These typical models are outlined below, and provide a context for data presented later in this
report.
Allied health
Supervision of students, trainees or interns in allied health traditionally involves one health
professional supervising one student, although approaches involving two or three students to
one health professional have become more common.
Dentistry
Teaching at the point of care typically involves one clinician supervising one student. There may
be circumstances, however, where one clinician supervises more than one dental student, such
as during dental hospital ward rounds.
Medicine
Traditionally, supervision of students and trainees in medicine is undertaken, in varying degrees,
by a range of medical professionals from registrars to consultants.
While consultants provide overarching supervision to registrars, junior doctors (PGY1 trainees)
and medical students, the day-to-day supervision of PGY1 trainees is undertaken by registrars.
In turn, the day-to-day supervision of medical students is undertaken by PGY1 trainees and
registrars. Group supervision is common a common approach used during hospital ward rounds.
Midwifery and nursing
The models of supervision used for midwifery and nursing are common across both disciplines.
Day-to-day supervision of nursing and midwifery students and trainees is provided under the
preceptor model of supervision. This model involves one registered nurse or midwife trained in
preceptorship providing point of care supervision to one student or trainee.
In addition to preceptorship supervision, management of student and trainee clinical placements
in nursing and midwifery is provided under the facilitator model of supervision. This model
involves one registered nurse or midwife trained in facilitation overseeing the management of a
number of student clinical placements. The facilitator model generally operates under a 1:6 or
1:8 ratio.
6
Clinical Supervision Support Program: Environmental Scan and research. John Ramsey & Associates 2011, data not yet published.
26
3.
OVERVIEW OF SUPERVISORS OF STUDENTS, TRAINEES AND
INTERNS IN NSW
Key findings
This section provides a brief profile of current supervisors of students, trainees and interns in
NSW. Detailed responses by discipline are provided in following sections.
• The electronic survey identified 1746 people who indicated they have provided supervision
to students, trainees and interns in NSW in the past 12 months.
• Of these, the majority of current supervisors identified as working in allied health (47.3%),
nursing (26.9%) or medicine (20.8%).
• Supervisors of students, trainees and interns were identified in all Local Health Districts
(LHDs) and Specialist Health Networks in NSW.
• The highest number were from South Eastern Sydney (n=187), Northern Sydney (n=179)
and Hunter New England (n=151). The lowest number were from Far West (n=18),
Nepean Blue Mountains (n=37) and Northern NSW (n=53).
• A total of 140 respondents identified as working within one of the Specialist Health
Networks.
• A small number of supervisors were identified in University (n=27) or TAFE/other
Vocational Education and Training (VET) sectors (n=11).
• The most common setting identified for supervision of students, trainees and interns was a
hospital/ward-based setting (42.6% of respondents).
• Just under one-quarter of supervisors (23.1%) identified as also working within a private
setting.
• Over three-quarters of people (76.3%) identifying as providing supervision were female.
Female supervisors outweighed male supervisors in all disciplines, with the exception of
medicine.
• The majority of supervisors identified were aged in their 30s (24.7%), 40s (29.2%) and 50s
(26.9%). Allied health supervisors tended to be in younger age groups than the other
disciplines.
• The structure and provision of supervision can differ between disciplines, locations and
contexts.
• Provision of supervision is influenced by the context in which it is provided.
3.1
OVERVIEW OF SURVEY RESPONSES
The electronic survey identified 1746 people who indicated they have provided
supervision to students, trainees and interns in NSW in the past 12 months.
In total, 2431 survey responses were received. Of these, 2276 were complete responses.
Seventy seven per cent (n=1746) of survey respondents indicated they have provided
supervision to students, trainees or interns within the past 12 months. These respondents were
guided to complete Path A of the survey.
The remaining 23% (n=530) had not provided supervision to students, trainees or interns within
the past 12 months and were guided to complete Path B.
27
3.2
DEMOGRAPHICS AND LOCATIONS OF CURRENT SUPERVISORS
3.2.1 Discipline of current supervisors
The majority of current supervisors identified as working in allied health, nursing or
medicine.
Information about primary discipline was available for 1745 people who completed this survey
and identified as providing supervision for students, trainees and interns in NSW (Figure 3.1). Of
these, the majority identified as working in allied health, nursing and medicine, with a small
number identified as working in dentistry and midwifery.
Figure 3.1: Primary discipline of people providing supervision for students, trainees and interns
(n=1745)
60
Allied health
Dentistry
% of respondents
50
47.3
Medicine
Midwifery
40
Nursing
30
26.9
20.8
20
10
2
2.9
0
3.2.2 Location of current supervisors in NSW
Supervisors of students, trainees and interns were identified in all LHDs and Specialist
Health Networks in NSW.
Information about LHD location was identified for 1403 people who identified in this survey as
providing supervision for students, trainees and interns in NSW. Of these:
• the highest number of respondents were from South Eastern Sydney, Northern Sydney
and Hunter New England (Table 3.1)
• the lowest number of respondents were from Far West, Nepean Blue Mountains and
Northern NSW
In addition:
• a total of 140 respondents identified as working within one of the Specialist Health
Networks (Table 3.2)
• a small number of supervisors were identified in University or TAFE/other VET sectors
(Table 3.3).
28
Table 3.1: Location of people providing supervision for students, trainees and interns in NSW, by
LHD (n=1403)
Local Health District:
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
76
Far West
18
Illawarra Shoalhaven
80
Hunter New England
151
Nepean Blue Mountains
37
Mid North Coast
75
Northern Sydney
179
Murrumbidgee
57
South Eastern Sydney
187
Northern NSW
53
South Western Sydney
109
Southern NSW
60
Sydney
118
Western NSW
78
Western Sydney
125
Total metropolitan
911
Total rural/regional
492
Specialist Health Network (n=140)
Specialist Health Network
Number of supervisors
Justice Health and Forensic Mental Health Network
28
Sydney Children's Hospital Network
80
St Vincent's Health Network
32
non-LHD institution (n=38)
Institution type
University
27
TAFE or other VET college
11
3.2.3 Work setting in which supervision is currently provided
The most common setting identified for supervision of students, trainees and interns was
a hospital/ward-based setting.
Information about the setting in which supervision is provided was identified for 1738 people who
identified in this survey as providing supervision for students, trainees and interns in NSW
(Tables 3.4 and 3.5). Of these:
• the most common setting identified for provision of supervision was a hospital/ward-based
setting (nominated by 42.6% of respondents)
• just under one-quarter of respondents (23.1%) identified as also working within a private
setting (Table 3.5)
• a total of 116 respondents (6.7%) identified as providing supervision in rural/remote
settings
• a total of 375 respondents (21.6%) identified as providing supervision in a communitybased setting
• around one quarter of respondents (23.1%) identified as practicing in a public and private
setting.
29
Table 3.4: Setting in which supervision is provided (n=1738)*
Setting in which supervision is provided
Supervisors
N
%
Sub-acute/rehabilitation
274
15.8
Aged care
213
12.3
Mental health
243
14.0
Primary health care
201
11.6
Community-based care
375
21.6
Rural remote care
116
6.7
Emergency
215
12.4
Hospital/ward-based care
741
42.6
369
21.2
Other
†
*Respondents could nominate more than one setting
†
The majority of ‘other’ responses referred to the specialty context in which the respondent works, such as surgical
theatres, radiology departments, intensive care, paediatrics, disability services and pharmacy dispensing. Other
comments referred to a range of outpatient settings. The spectrum of remaining ‘other’ responses included Aboriginal
Medical Services, management/administration roles, public health/health promotion, private practice, university and
other educational settings and Justice Health.
Table 3.5: Sector in which supervisors work (n=1510)
Private sector work
Supervisors
N
%
Supervisors who work in public and private setting
349
23.1
Supervisors who only work in a public setting
1161
76.9
3.2.4 Demographics of current supervisors
The majority of current supervisors identified were female and aged in their 30s, 40s and
50s.
Information about demographics was provided for 1510 people who identified in this survey as
providing supervision for students, trainees and interns in NSW. Of these:
• over three-quarters of respondents were female (76.3%) (Figure 3.4)
• female respondents outweighed male respondents in all discipline categories, with the
exception of medicine (see individual sections for breakdowns by discipline)
• the majority of supervisors were aged in their 30s (24.7%), 40s (29.2%) and 50s (26.9%)
(Figure 3.5)
• allied health professional respondents tended to be in younger age categories, whereas
nursing and midwifery respondents tended to be in older age categories (see Sections 4–
8 for breakdowns by discipline).
30
Figure 3.2: Gender of people providing supervision for students, trainees and interns in NSW
(n=1510)
23.7%
Male
Female
76.3%
Figure 3.3: Age of people providing supervision to students, trainees and interns in NSW (n=1510)
50
20–29 years
30–39 years
% of respondents
40
40–49 years
50–59 years
29.2
30
24.7
60+ years
26.9
20
13.4
10
5.8
0
3.3 CONTEXT AND CULTURE OF SUPERVISION
3.3.1 Structure of supervision
The structure and provision of supervision can differ between disciplines, locations and
contexts.
Interview responses and background research indicated that the structure of supervision can
differ between disciplines, locations and contexts. Supervision can be provided on many levels,
from a one-on-one interaction between the supervisor and student at the point of patient care, to
a broader review of multiple students on clinical placement.
Students, trainees and interns may experience supervision on one or more of these levels.
One-on-one supervision
Often referred to as a 1:1 model, one-on-one supervision involves one clinician supervising one
student, trainee or intern. This supervision is generally provided at the point of patient care, and
may extend to reflection or discussion away from the clinical setting.
31
One-on-one supervision is typical across all disciplines; however, the terminology used to
describe this model can vary. For example, in nursing and midwifery a one-on-one supervisory
relationship may be referred to as a ‘preceptorship’ or a ‘mentorship’.
Provision of one-on-one supervision in each discipline is described in more detail in the relevant
discipline chapters.
Group supervision
Group supervision involves one clinician supervising a group of students, trainees or interns.
Common ratios of group supervision include a 1:6 model and a 1:8 model. Group supervision
may also take the form of educational tutorials or seminars provided to a group of students,
trainees or interns undertaking a common clinical placement.
Group supervision activities are common in war-based medicine and nursing, and hospitalbased dentistry. Multiple students or interns may accompany a single medical or dentistry
professionals on a ward round.
Provision of group supervision in each discipline is described in more detail in the relevant
discipline chapters.
Overarching supervision
Overarching supervision involves clinician overseeing the supervision of one or multiple
students, trainees and interns during a clinical placement.
An overarching supervisor may be a senior clinician who manages staff who in turn provide
supervision to students, trainees and interns. An example of overarching supervision is the role
of a consultant in a medical setting. The consultant will oversee the supervision of a medical
student during a clinical placement. However, point-of-care supervision will be provided by a
registrar or junior doctor on a day-to-day basis.
Alternatively, an overarching supervisor may be a clinician who has been specifically appointed
for the task of overseeing supervision within their clinical setting. An example of is the role of a
facilitator in nursing and midwifery. A facilitator is responsible for overseeing the supervision of
students and trainees during a clinical placement. However, they may or may not be involved in
direct, point-of-care supervision of these students.
Overarching supervisors often have a direct relationship with the student’s training institution. As
such, they are typically involved in the assessment of students, trainees and interns during
clinical placements.
3.3.2 Context of supervision
Provision of supervision is influenced by the context in which it is provided.
Interviews were conducted with individuals involved in the supervision of students, trainees and
interns across a variety of different contexts. These interviews highlighted a number of contextspecific considerations for the provision of supervision. This section provides some case
examples of contextual differences in the provision of supervision.
Regional and rural settings
Interviews with individuals involved in the supervision of students, trainees and interns in rural
and regional settings indicated a number of context-specific issues impacting on the nature of
supervision within this setting.
Clinical placements at rural and regional sites are often viewed as an opportunity to introduce
and orientate students, trainees and interns with the site, in the hope of retaining those students
in full-time employment. Students, trainees and interns are often rotated through a number of
32
clinical settings within one long-term placement block in order to give them ample exposure to
the site.
“ … (long term placement) enables the student to have quite a good orientation
program initially on to the campus site, then facilitate high quality supervision
over the types of units that they require exposure to. That also enables us as a
potential employer of that student in the future to get a good feel for them and
them for us. And it often does translate to at least, if not successful employment,
a job application.”
Under these circumstances, however, supervisors may find difficulty in remediating an
underperforming student, trainee or intern who may one day become their colleague.
“I know a lot of supervisors struggle with it (remediation of students) … they have
been bold and they have spoken to the university quite candidly about their
concerns. They find that well, the student has had to do a couple more weeks
somewhere else and then they are launched in to the workplace and are now a
colleague.”
The vast amounts of land covered by some regional and rural Local Health Districts (LHDs), as
well as the distances between communities, means that health professionals need to adapt their
style of supervision.
“…the distances are quite large and it does mean that the style of supervision
therefore is something that perhaps students aren’t expecting.”
While day-to-day supervision of students, trainees and interns occurs at the point of patient care,
oversight of their placement by their training institution may happen remotely.
“What we do is a mixture of our staff going there, but also having the staff
contactable by mobile phone by the students at the facilities …. so it just creates
another way of being in touch because …. it’s just a problem with distance.”
Case example
An example of remote supervision of a psychology intern was provided during the telephone
interviews.
The intern was due to complete a two-year internship at a regional site which had no practicing
psychologist, with a principal supervisor based in a regional city.
For the initial six months of the internship, the psychology intern worked in a supernumerary
capacity alongside the principal supervisor in the city. Following this, the supervisor and intern
then made use of videoconferencing facilities for the remainder of the 18-month internship,
which was completed remotely.
Speciality Health Service settings
Interviews with individuals involved in the supervision of students, trainees and interns in
Speciality Health Service settings highlighted a number of context-specific considerations that
need to be taken into account when supervising students within these settings.
Examples included:
• ensuring that any student, trainee or intern working within a paediatric setting has
undergone a ‘working with children’ check
• ensuring that students working in high-security facilities are well orientated to the setting.
33
Justice and Forensic Mental Health is an example of a Specialty Health Service setting in which
additional considerations are taken into account for the supervision of students, trainees and
interns.
Case example
Justice and Forensic Mental Health comprises various health care settings, including a hospital
at Long Bay Correctional Facility, health centres at correctional facilitates state-wide, and
community-based care and forensic facilities. Supervision of students, trainees and interns
within this high security setting is strictly regulated.
“… we are very particular in that component because we cannot be probably as
easy-going as some of the other places …”
Justice and Forensic Mental Health provides training institutions with a detailed schedule
outlining the supervision model and the requirements of the university prior to sending students,
trainees and interns on placements. All trainees who undertake a placement within Justice and
Forensic Mental Health are required to attend Long Bay hospital for a one-day, face-to-face
orientation in which the context of the service is provided, security issues are addressed and
learning opportunities and goals are discussed.
Supervision tends to be provided on a one-on-one basis, and is only provided by Justice and
Forensic Mental Health staff. This means that no supervision can be provided by staff from
training institutions.
Specific skills are required of supervisors within the Justice and Forensic Mental Health setting.
Supervisors are required to understand their context with regard to the range of stakeholders
involved, and be confident to facilitate conversations between these stakeholders.
“If there’s a stranger in the midst, it starts all sorts of questions”
The Justice and Forensic Mental Health workforce also tends to be more mature. As such, an
understanding of the learning styles of a younger generation of students, trainees and interns is
a core skill required of supervisors in this setting.
3.3.3 Culture of supervision
Interview and survey responses provided some additional information about factors influencing
how supervision is provided during clinical placements. This section, while reflective of the
current culture of supervision across disciplines, provides only a snapshot of the thoughts and
opinions of some interview participants.
Recognition of supervision
Interview responses indicated that the culture of the health workforce is such that provision of
supervision to less qualified staff, including students, trainees and interns, is generally expected
of all clinicians. As such, the role of supervisors may be undervalued, resulting in little incentive
to take on and maintain supervisory skills.
Interviews suggested that supervision can be seen as an additional burden, but should instead
be valued as a core component of best practice.
“… embedded throughout that is about legitimising the impact of supervision on patient
outcomes, service delivery, that it’s something that is crucial to health care, to our community
and our future workforce.”
34
“… it’s about how do we reinforce its (supervision’s) significance and importance so the people
who are putting up their hand and the people who are supporting that, and the managers etc,
can actually legitimise the investment in supervision, the investment of the individuals, and make
that link to patient outcomes and health service delivery and our future workforce service
delivery models.”
Continuum of supervision
Interview responses highlighted the need for recognition of the continuum of clinical supervision.
Supervision is not limited to students, trainees and interns but continues for qualified health
professionals beyond their PGY1 year.
“The workforce is generally good at thinking about the trainee. I think it drops off
there and I think that’s the part that we don’t yet have a good handle on and
that’s the area that we need to develop.”
“Our trainee stage is relatively robust and acknowledged and accepted. It’s what
happens after that first year that we’re needing to work on… i.e. when a person
moves outside of the formal trainee period in their first year and either becomes a
qualified paramedic who’s a graduate or they’re moving on with the vocational
program into the paramedic intern stage.”
In addition, interview responses suggested that supervision should not focus only on the
supervisor/trainee relationship but should be reflected throughout the health service, using more
junior staff in informal mentoring roles and encouraging all staff to develop, support and motivate
students, trainees and interns
“Clinical supervision is not just about a trainee, it’s about all the – we use the term loosely
‘senior officers’ – understanding they have a responsibility to develop, support,
encourage, motivate and perhaps keep an eye on junior officers and keep the standard
raised and keep the bar high and that sort of becomes a generational thing and a cultural
thing. That’s the area that we really need to work on.”
35
4.
PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND
INTERNS IN ALLIED HEALTH
Key findings
• The approach to supervision of allied health students, trainees and interns in NSW varies
by discipline and location.
• The electronic survey identified 826 current supervisors and 201 potential supervisors of
allied health students, trainees and interns in NSW.
• Supervisors of allied health students, trainees and interns were identified in all Local
Health Districts (LHDs) and all Specialist Health Networks in NSW.
• The most common work settings for supervisors of allied health students, trainees and
interns in NSW were hospital and ward-based settings (35%) and community-based
settings (30.3%).
• The majority of supervisors of allied health students, trainees and interns identified were
female (86%) and in younger age groups (60% were in their 20s and 30s).
• The majority of supervisors of allied health students, trainees and interns identified
indicated that supervision is a formal or expected part of their role (71.7%), but is not
specifically funded (74.9%).
• The most common approach to supervision of allied health students, trainees and interns
nominated by current supervisors was direct supervision, provided through a team or
one-to-one approach.
• Supervisors of allied health students, trainees and interns had a broad range of years of
experience both as a clinician and as a supervisor (average of 13.9 ± 9.6 years and 9.8 ±
8.3 years, respectively).
• Training in supervision for supervisors of allied health students, trainees and interns is
typically provided by the students’ training institution.
• In total, 189 supervisors of allied health students, trainees and interns identified had
undertaken formal training and 531 had undertaken some informal training in
supervision.
• Placements for allied health students, trainees and interns tend to be longer-term (> 1
month).
• The majority of supervisors of students, trainees and interns in allied health typically work
in full-time roles. The time spent providing supervision varies from less than 5 hours per
week to more than 30 hours per week.
• Over half (58%) of current supervisors of allied health students, trainees and interns
indicated they are at capacity, and could not take on further supervision.
• Around one-third (32.6%) of current supervisors of allied health students, trainees and
interns indicated some capacity for additional supervision, and around half (50.4%) of
those not providing supervision indicated interest and capacity to provide supervision.
• For current and non-current supervisors of students, trainees and interns in allied health,
the major factor influencing capacity to undertake supervision is the balance between
service delivery and teaching.
• The most important core skill for supervisors nominated by current supervisors of students,
trainees and interns in allied health was ‘clinical skills and knowledge’. The least
important skill was ‘remediation of underperforming students’.
36
4.1
OVERVIEW OF STUDENT, TRAINEE AND INTERN SUPERVISION IN ALLIED HEALTH
Approaches to supervision of students, trainees and interns in allied health vary by
discipline and location.
The approach to supervision of students, trainees and interns in allied health varies by discipline
and by location. Professional bodies representing the allied health disciplines may influence the
approach taken by way of accreditation processes and requirements. Other allied health
disciplines have registering bodies that may influence the requirements of a training placement.
Interviews with allied health professionals involved in the oversight of supervision for students,
trainees and interns highlighted that supervision typically occurs at the point of patient care with,
in many cases, a 1:1 supervisor to student ratio.
In some facilities, training institutions co-fund or fund a student supervisor position. The student
supervisor is usually managed internally by the head of discipline department.
“One of the challenges that we have in allied health is just the … infinitely large
number of disciplines that we have, each of which have separate accreditation
processes through the universities and the professional associations. So for
some of the disciplines, the associations for example may have something to say
about students…”
4.2
PROFILE OF SUPERVISORS OF ALLIED HEALTH STUDENTS, TRAINEES AND
INTERNS
4.2.1 Number of supervisors of allied health students, trainees and interns
The electronic survey identified 826 current supervisors and 201 potential supervisors of
allied health students, trainees and interns in NSW.
This survey identified:
• 826 individuals who indicated they have provided supervision for allied health students,
trainees and interns in the past 12 months (Figure 4.1)
• 201 allied health professionals who indicated they have not provided supervision for
students, trainees and interns in the past 12 months, but have provided supervision
previously (Figure 4.1); these people represent a potential additional source of
supervisors in NSW.
Figure 4.1: Allied health professionals who are currently supervising, have previously supervised
or have never supervised students, interns and trainees (n=1139)
Number of respondents
900
Within the past 12 months
826
800
In the past (> 12 months ago)
700
Never
600
Unsure
500
400
300
200
100
201
111
1
0
37
4.2.2 Number of supervisors of allied health students, trainees and interns, by subdiscipline
Supervisors of allied health students, trainees and interns indicated that they provide
supervision for a range of allied health sub-disciplines.
Information about the discipline of students, trainees and interns for whom supervision is
provided was identified by 767 allied health survey respondents. Of these:
• the highest number of respondents,159 (20.7%), indicated that they provide supervision to
occupational therapy students, trainees and interns (Table 4.1)
• a total of 123 respondents (16.0%) indicated that they provide supervision to speech
pathology students, trainees and interns
• 105 respondents (13.7%) indicated that they provide supervision to social work students,
trainees and interns
• five respondents indicated that, in addition to providing supervision for allied health
students, trainees and interns, they also provide supervision for non-allied health
disciplines
• one respondent indicated that they provide supervision to students, trainees and interns
from more than one allied health discipline
• ‘other’ student, trainee and intern disciplines for whom supervision is provided, nominated
by 46 respondents included: allied health assistant, audiometrist, divisional therapist,
early childhood intervention trainees, Clinical psychologist, dietitian aides, dental/oral
health assistants, health service management interns, leisure and health TAFE students,
mammographer, mental health and rehabilitation counsellors, pharmacy technicians,
pathology collectors and pastoral care and chaplain trainees.
Table 4.1: Allied health professionals who are currently supervising, have previously supervised
or have never supervised students, interns and trainees (n=767)*
Discipline of students, trainees and interns
n
%
Aboriginal health worker
5
0.7
Art Therapist
5
0.7
Audiologist
0
0.0
Chiropractor
4
0.5
Counsellor
7
0.9
Dietitian
98
12.8
Diversional Therapist
4
0.5
Exercise Physiologist
20
2.6
Genetics Counsellor
13
1.7
Medical radiation scientist – diagnostic radiographer
24
3.1
Medical radiation scientist – nuclear medicine
3
0.4
Medical radiation scientist – radiation therapist
14
1.8
Music Therapist
1
0.1
Occupational Therapist
159
20.7
Orthoptist
26
3.4
Orthotist/prosthetist
2
0.3
38
Discipline of students, trainees and interns
n
%
Pharmacist
23
3.0
Physiotherapist
85
11.1
Podiatrist
12
1.6
Psychologist
59
7.7
Social Worker
105
13.7
Speech Pathologist
123
16.0
Welfare Officer
2
0.3
Other
46
5.9
*Respondents could nominate more than one discipline of students, trainee and interns for whom they provide
supervision.
4.2.2 Location of current supervisors of allied health students, trainees and interns
Supervisors of allied health students, trainees and interns were identified in all LHDs and
Specialist Health Networks in NSW.
Of the survey respondents who identified as providing supervision for allied health students,
trainees and interns:
• the highest number were from Hunter New England, Northern Sydney and South Eastern
Sydney (Table 4.2)
• the lowest number were from Far West, Nepean Blue Mountains and Mid North Coast
• a total of 66 were working in one of the Specialist Health Networks (Table 4.3)
• a small number were working in University or TAFE/other Vocational Education and
Training (VET) sectors (Table 4.4).
Table 4.2: Location of supervisors of allied health students, trainees and interns in NSW, by LHD
(n=695)
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
35
Far West
34
Hunter New England
100
22
Mid North Coast
23
Northern Sydney
88
Murrumbidgee
24
68
Northern NSW
29
72
Southern NSW
20
Sydney
58
Western NSW
57
Western Sydney
60
Total metropolitan
437
258
5
39
Table 4.3: Location of supervisors of allied health students, trainees and interns in NSW, by
Specialist Health Network (n=66)
Number of
supervisors
5
45
16
Table 4.4: Location of supervisors of allied health students, trainees and interns in NSW, by nonLHD institution (n=11)
Institution type
Number of
supervisors
University
9
2
4.2.3 Work setting in which supervision is currently provided for allied health students,
The most common work setting for supervisors of allied health students, trainees and
interns identified in NSW were hospital and ward-based settings and community-based
settings.
• just over one-third (35%) indicated that supervision is provided in a hospital or ward-based
setting (Table 4.5)
• a total of 63 (7.6%) allied health supervisors identified as providing supervision in
rural/remote settings
• a total of 250 (30.3%) allied health respondents identified as providing supervision in a
community-based setting
• ‘other’ settings, nominated by 170 respondents included: specialty contexts such as
radiology, paediatrics, palliative care, imaging, disability services, and drug and alcohol
services; a range of outpatient settings; Aboriginal Medical Services;
management/administration roles; public health/health promotion; research; private
practice; university clinics; schools; and teaching environments.
Table 4.5: Setting in which supervision of allied health students, trainees and interns is provided
(n=824)*
Supervisors
n
%
186
22.6
Aged care
118
14.3
Mental health
120
14.6
Primary health care
98
11.9
250
30.3
Rural remote care
63
7.6
40
Supervisors
n
%
Emergency
55
6.7
288
35.0
170
20.6
Other
†
†
Survey respondents were asked to identify if they also worked in a private setting, in addition to their work in the
public health settings listed in Table 4.4. Information was received from 740 allied health supervisors. Of these, 20.4%
indicated they also work within a private setting.
4.2.4 Demographics of supervisors of allied health students, interns and trainees
The majority of supervisors of allied health students, trainees and interns identified in
NSW were female and tended to be in younger age groups.
• over three-quarters (84.6%) were female (Figure 4.2)
• the majority were aged in their 20s (30.8%), 30s (29.2%) and 40s (26.9%) (Figure 4.3)
Figure 4.2: Gender of people providing supervision for allied health students, trainees and interns
in NSW (n=740)
15.4%
Male
Female
84.6%
41
Figure 4.3: Age of people providing supervision to allied health students, trainees and interns in
NSW (n=740)
50
45
% of respondents
40
35
20–29 years
30.8
30
25
30–39 years
23.1
23.2
40–49 years
19.5
20
50–59 years
60+ years
15
10
3.4
5
0
4.2.5 Recognition of the role of student, trainee and intern supervision in allied health
The majority of supervisors of allied health students, trainees and interns identified in
NSW indicated that supervision is a formal or expected part of their role, but is not
specifically funded.
• just under three-quarters (71.7%) indicated that supervision of students, trainees and
interns is a formally recognised part of their role (Figure 4.4)
• a similar proportion (74.9%) indicated they receive no funding for the provision of
supervision of students, trainees and interns (Figure 4.5).
Findings from the electronic survey were supported by interview responses, which suggested
that supervision of students, trainees and interns was generally an expected and recognised part
of an allied health professional’s role, although it is not specifically funded. Recognition of
supervision within allied health is guided by the NSW Health Professions Award. Most senior
staff graded as Level 2 or above will have an expectation of student supervision written into their
role.
“… once you hit Level 2 it is an expectation that you would be capable of, and
you will take, students.”
“They will often have a key accountability or criterion in their selection criteria
about the broader concepts of supervision. Not only for students, but in taking on
junior and other clinicians within the LHD, providing a supervisory relationship.”
42
Figure 4.4: Role definition for supervisors of allied health students, trainees and interns in NSW
(n=820)
100
Formal
90
% of respondents
80
Not formal
Unsure
71.7
70
60
50
40
30
20.1
20
8.2
10
0
Figure 4.5: Proportion of role funded for provision of supervision of allied health students, trainees
and interns in NSW (n=762)
100
Not funded
90
% of respondents
80
Partially funded
Fully funded
74.9
Unsure
70
60
50
40
30
20
11.4
9.8
10
3.8
0
4.2.6 Approach to supervision of students, trainees and interns in allied health
The most common approach to supervision of allied health students, trainees and interns
nominated by current supervisors was direct supervision, provided through a team or
one-to-one approach.
• the most common approaches to supervision nominated were a team approach and a oneto-one approach (Table 4.6)
• direct supervision was the most common type of supervision identified (Table 4.7)
• interdisciplinary supervision was identified as being used by almost one-quarter of allied
health respondents (Figure 4.6)
43
• the most common type of interdisciplinary supervision identified was informal ‘on-the-job’
supervision (Table 4.8).
Table 4.6: Approach to supervision of allied health students, trainees and interns in NSW (n=822)*
Approach to supervision
Respondents
n
%
One-to-one
299
36.4
One to > one
142
17.3
404
49.1
66
8.0
Team approach
Other approach
†
†
One of the most common ‘other’ responses referred to a combination of all approaches, depending on factors such
as staff availability and student numbers and needs. Some responses clarified that their ‘team approach’ was shared
between two colleagues only, in some cases due to job share arrangements between part-time staff. Others referred
to their roles as student placement coordinators or as managers overseeing or mentoring student supervisors.
Table 4.7: Type of supervision provided for allied health students, trainees and interns in NSW
(n=806)*
Type of supervision provided
Respondents
n
%
Direct (present, observing, working with, directing students)
712
88.3
Indirect (easily contactable, not directly supervising)
235
29.2
Providing education support, assessment and feedback
412
51.1
Providing guidance, pastoral care, mentoring support
259
32.1
Other role
19
2.4
Figure 4.6: Interdisciplinary supervision of students, interns and trainees by allied health
professionals in NSW (n=755)
1.7%
Yes
24%
No
Unsure
74.3%
44
Table 4.8: Type of interdisciplinary supervision provided for students, trainees and interns by
allied health professionals in NSW (n=178)*
Respondents
Type of supervision
n
%
Formal workplace supervision
53
29.8
Informal ‘on-the-job’ supervision
118
66.3
Both formal and informal supervision
2
1.1
Other
5
2.8
4.2.7 Years of experience of supervisors of allied health students, trainees and interns
Supervisors of allied health students, trainees and interns identified in NSW had a broad
range of years of experience both as a clinician and as a supervisor.
trainees and interns in NSW:
• the average number of years of experience as an allied health professional was 13.9 ± 9.6
(Figure 4.7)
• the average number of years of experience in providing supervision to allied health
students, trainees and interns was 9.8 ± 8.3.
Average number of years experience
Figure 4.7: Average years of experience as an allied health professional clinician (n=793) and
supervisor of allied health students, trainees and interns (n=739)
Average years of experience as
a clinician
Average years of experience as
a supervisor
25
20
15
13.9
9.8
10
5
0
45
4.2.8 Training in supervision of allied health students, trainees and interns
Training in supervision for supervisors of allied health students, trainees and interns is
typically provided by the students’ training institution. Supervisors may also undertake
formal and informal training.
Interviews with allied health professionals indicated that training to provide supervision to
students, trainees or interns is generally offered by the students’ training institution. These
training institutions are incentivised to offer training to allied health professionals as it may
ultimately lead to greater capacity for a facility to take on supervision.
“… what we’ve found is the universities, they’re usually really keen to build
capacity for student placement, so they try and make it as easy as possible for
our staff to… take students and they will usually offer the training, or even if
there’s enough numbers, come to our facilities to provide that training.”
Training for current supervisors
• 189 indicated they had undertaken some form of formal training in supervision (Table 4.9)
• the most common form of training undertaken was a Certificate IV in Workplace Training
and Assessment
• 531 indicated they had undertaken some form of informal training in supervision (Table
4.10)
• the most common form of informal training undertaken was a University-delivered
program.
Some respondents reported having completed discipline-specific training in supervision offered
or required by professional organisations including: Pharmaceutical Society of Australia,
Psychology Board of Australia, and Australian Association of Social Workers.
Table 4.9: Formal training in supervision undertaken by supervisors of allied health students,
†
trainees and interns in NSW (n=189)*
Type of formal training
Respondents
n
%
Certificate IV in Workplace Training and Assessment
72
38.1
Graduate certificate
48
25.4
Graduate diploma
39
20.6
Master’s
61
32.3
Doctorate
7
3.7
*People could choose more than one training program
†
Comments fields indicate that many respondents included qualifications that have a component (e.g. one subject
about supervision) or some relevance to supervision (e.g. Education degree) rather than qualifications solely focused
on supervision
46
Table 4.10: Informal training in supervision undertaken by supervisors of allied health students,
trainees and interns in NSW (n=531)*
Type of informal training
Respondents
n
%
LHD-run seminar/workshop (1–3 days)
79
14.9
LHD-run course
35
6.6
External seminar/workshop (1–3 days)
196
36.9
University-delivered program (e.g. facilitator training)
366
68.9
Training for non-supervisors
Of allied health survey respondents who indicated they had not provided supervision for
students, trainees and interns in the past 12 months:
• the most common form of supervision training undertaken was a Master’s degree
4.12)
• the most common form of informal training undertaken by allied health professionals was a
workshop or seminar run external to the LHD.
Sources of training mentioned by respondents included the Psychology Board of Australia and
Relationships Australia.
Table 4.11: Formal training in supervision undertaken by non-supervising allied health
professionals (n=102)*
Respondents
n
%
27
26.5
12
11.8
Graduate diploma
20
19.6
Master’s
47
46.1
Doctorate
8
7.8
47
Table 4.12: Informal training in supervision undertaken by non-supervising allied health
professionals (n=134)*
Respondents
n
%
20
14.9
LHD-run course
10
7.5
64
47.8
University-delivered program (e.g. facilitator training)
86
64.2
4.3
CAPACITY FOR SUPERVISION OF STUDENTS, TRAINEES AND INTERNS IN ALLIED
HEALTH
4.3.1 Duration of allied health student, trainee and intern placements
Placements for allied health students, trainees and interns tend to be longer-term (> 1
month).
Survey responses from individuals who identified as providing supervision for students, trainees
and interns in allied health illustrated that the duration of placements for students, trainees and
interns in allied health is varied. Placements of one to six months were most commonly reported.
(Table 4.13)
Table 4.13: Typical duration of allied health student, trainee and intern placements in NSW (n=771)
Duration of placement
Respondents
n
%
Short-term (1–4 days)
170
22.0
Medium-term (1 week – 1 month)
297
38.5
Long-term (1–6 months)
480
62.3
Extended long-term (6–12 months)
64
8.3
Full-time (12 months)
97
12.6
*People could choose more than duration of placement
4.3.2 Time spent supervising allied health students, trainees or interns
The majority of supervisors of students, trainees and interns in allied health typically
work in full-time roles. The time spent providing supervision varies from less than 5
hours per week to more than 30 hours per week.
Of the survey respondents who identified as providing supervision for students, trainees and
interns in allied health:
• the majority (79.2%) were working in full-time roles (more than 30 hours per week) (Table
4.14)
• around one-quarter (24.4%) indicated they provide less than 5 hours of supervision per
week (Table 4.15)
• over 18% of allied health respondents indicated they provide 30 or more hours of
supervision per week.
48
Table 4.14: Average number of hours worked per week by individuals providing supervision to
allied health students, trainees and interns in NSW (n=740)
Average hours worked per week
Respondents
n
%
<15
10
1.4
15–20
42
5.7
20–25
55
7.4
25–30
47
6.4
30+
586
79.2
Table 4.15: Average number of hours per week spent supervising allied health students, trainees
Average hours providing supervision to students,
trainees and interns per week
Respondents
n
%
<1–5
196
24.4
5–10
138
17.2
10–15
82
10.2
15–20
91
11.3
20–25
70
8.7
25–30
76
9.5
30+
151
18.8
4.3.3 Capacity to undertake supervision
Over half of current supervisors of allied health students, trainees and interns indicated
they are at capacity, and could not take on further supervision.
Around one-third of current supervisors of students, trainees and interns in allied health
indicated some capacity for additional supervision, and around half of those not
providing supervision indicated interest and capacity to provide supervision.
Current supervisors
interns in allied health:
• over half (58%) indicated they were at capacity and could not take on further supervision
(Table 4.16)
• around one-third (32.6%) indicated they had some capacity for additional supervision.
49
Table 4.16: Supervision capacity for current supervisors of allied health students, trainees and
interns in NSW (n=778)
Level of capacity for supervision
Respondents
n
%
At capacity
451
58.0
Some capacity
254
32.6
Underutilised
23
3.0
Other*
50
6.4
*Comments provided as ‘other’ responses are reported together with factors impacting on capacity to undertake
supervision in Section 4.3.4
People not currently providing supervision
Of allied health survey respondents who indicated they had not provided supervision for
• around half (50.4%) indicated they had capacity and interest in undertaking supervision
(Table 4.17).
Table 4.17: Supervision capacity for allied health professionals not currently providing supervision
of students, trainees and interns (n=280)
Level of capacity
Respondents
n
%
No capacity
98
35.0
Capacity and interested
141
50.4
Not interested
20
7.1
Unsure
21
7.5
4.3.4 Factors impacting on capacity to undertake supervision
For current and non-current supervisors of students, trainees and interns in allied health,
the major factor influencing capacity to undertake supervision is the balance between
Current supervisors
• the major factor reported to influence capacity for all disciplines was the balance between
service delivery and teaching (Table 4.18)
• other high-rating factors included staff to patient ratios (37.3%) and dealing with
underperforming students (28.7%)
• incentives were identified as a factor by 23.4% of respondents.
50
Table 4.18: Factors affecting capacity for supervision of allied health students, trainees and
interns in NSW for current supervisors (n=774)*
Factors affecting capacity
Respondents*
n
%
Finding a balance between service delivery and teaching
654
84.5
Dealing with underperforming students
222
28.7
Staff to patient ratios
289
37.3
Student assessment tools
84
10.9
Incentives for supervisors
181
23.4
Ease of dealing with universities, TAFE or other colleges
129
16.7
Access to training
93
12.0
Feeling confident in supervising others
121
15.6
132
17.1
Other
†
*People could nominate more than one factor affecting capacity. Percentages are based on respondents not
responses.
†
Themes arising in the ‘other’ responses are reported together with factors that affect their capacity to increase the
amount of supervision they are undertaking below
The following were identified by allied staff who are currently providing supervision as factors
that influence their capacity to undertake more supervision:
• caseload/workload requirements
• lack of access to facilities such as dedicated office space or teaching rooms (mentioned
frequently), computers and other technology
• low staffing levels
• junior staff with clinical supervision requirements
• lack of student interest in particular field e.g. rural placements or due to compulsory
placement
• unpredictable range in student capabilities and learning requirements
• impact or overlap of placement timeframes with other service requirements
• administrative requirements of supervisors.
Information about barriers to supervision was identified for the 203 allied health professionals
who did not indicate a lack of interest in providing supervision for students, trainees and interns:
• the most common barrier identified was the balance between service delivery and teaching
(nominated by 31.0% of respondents) (Table 4.19).
51
Table 4.19: Factors affecting capacity for supervision of allied health students, trainees and
interns in NSW for those not providing supervision (n=203)*
Respondents*
n
%
Difficulty finding a balance between service delivery and
teaching
70
31.0
Low staff to patient ratios
42
19.7
Low supervisor to student ratios
10
4.9
Lack of support for underperforming students
15
5.9
Lack of consistent assessment tools
1
0.5
Lack of incentives for supervisors
33
14.8
Dealings with universities, TAFE or other colleges
17
7.4
Access to training
29
13.8
Currently involved in supervision of registered staff
33
14.3
Not feeling confident in supervising others
36
16.3
93
43.3
†
Other
responses.
†
Themes arising in the ‘other’ responses are reported together with factors that would help improve capacity to
undertake supervision below
The following were identified by allied staff who are not currently providing supervision as factors
that would help improve their capacity to undertake supervision:
• access to training
• supportive management – in undertaking training and supervision
• more clinical experience (new to clinical role)
• dedicated time for supervision
• backfill for positions while undertaking training and/or supervision
• lower caseloads/workloads
• incentives to undertake training and supervision (financial and role recognition)
• improved communication with and support from universities
• facilities for supervision (e.g. available rooms)
•
sufficient staffing levels.
52
4.4
CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR ALLIED HEALTH
STUDENTS, TRAINEES AND INTERNS
4.4.1 Rating of perceived core skills for supervisors
The most important core skill nominated by supervisors of students, trainees and interns
in allied health was clinical skills and knowledge. The least important skill was
remediation of underperforming students.
Survey respondents were asked to rank seven core skills of a supervisor in order of importance.
It should be noted that the list of skills provided was static for all respondents (i.e. the order in
which the list appeared was the same for each participant). It is acknowledged that the order in
which the skills were presented may have influenced the ranking of core skills.
• ‘clinical skills and knowledge’ was identified as the most important core skill by 48%
(n=328) of respondents (Figure 4.8), a further 20% of respondents ranked it as the
second most important skill.
• ‘interpersonal skills’ was identified as the most important core skill by 19% (n=132) of
respondents, a further 19% of respondents ranked it as the second most important skill.
• ‘ability to give and receive feedback’ was identified as the most important core skill by 14%
(n=95) of respondents, a further 20% of respondents ranked it as the second most
important skill
• ‘remediation of underperforming students’ was identified as the least important of the
seven core skills by 34% of respondents (Figure 4.9).
Figure 4.8 Core skill ranked as most important (rank=1) for supervisors of allied health students,
% of respondents
100
Clinical skills and knowledge
90
Adult teaching and learning skills
80
Ability to give and receive feedback
Appraisal and assessment
70
Self-evaluation and reflection
60
50
Remediation of poorly performing students
48
Interpersonal skills
40
30
20
10
19
12
14
7
2
3
0
53
Figure 4.9: Core skill ranked as least important (rank=7) by supervisors of allied health students,
100
90
% of respondents
80
70
60
50
40
34
30
19
20
10
14
5
11
10
2
0
A total of 262 survey respondents who indicated that they had not provided supervision for allied
health students, trainees and interns in the past 12 months attempted to rank the core skills of a
supervisor. Of these:
• ‘clinical skills and knowledge’ was identified as the most important core skill (i.e. a rank of
1 or 2) by 67.9% (n=163) of respondents
• ‘remediation of poorly performing students’ was identified as the least important core skill
(i.e. a rank of 6 or 7) by 62.5% (n=158) of respondents.
Table 4.20: Core skill required for supervisors, as ranked by people not currently providing
supervision of medical students, trainees and interns*
Rank 1–2
Rank 3–5
Rank 6–7
% of respondents
% of respondents
% of respondents
(n=240)
67.9
22.1
10.0
(n=236)
28.8
45.3
25.8
(n=232)
35.3
54.7
9.9
Appraisal and assessment (n=237)
10.5
61.6
27.8
(n=234)
19.7
50.0
30.3
Remediation of poorly performing
students (n=253)
10.7
26.9
62.5
Interpersonal skills (n=262)
40.5
37.4
22.1
Perceived core skills
*Not all respondents ranked all skills
54
4.5 INCREASING SUPERVISORY CAPACITY
Further information regarding supervisory skill gaps, and suggested approaches to address
these gaps with a view to increasing capacity, were gathered through the electronic survey and
key informant interviews. These findings are reported in full in Chapter 9.
55
5.
PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND
INTERNS IN DENTISTRY
Key findings (note: small numbers of respondents for this section)
• Local Health Districts (LHDs) and universities work together in the provision of supervision
to dental students, trainees and interns.
dental students, trainees and interns in NSW.
• Supervisors of dental students, trainees and interns were identified in both metropolitan
and rural LHDs, as well as in training institutions in NSW.
• The most common work settings for identified supervisors of dental students, trainees and
interns were primary health care (44%) and community-based care (23.5%).
• The majority of supervisors of dental students, trainees and interns were female and over
30 years of age (93.6%).
• The majority of supervisors of dental students, trainees and interns identified indicated that
supervision is a formal or expected part of their role (82.5%). These roles are generally
not funded (34.5%) or partially funded (37.5%).
• The most common approach to supervision of dental students, trainees and interns
nominated by current supervisors was direct supervision (68.6%), provided by a team of
supervisors (62.9%), or by a single supervisor with a team of students (28.6%).
• Interdisciplinary supervision by dentistry professionals is uncommon.
• Supervisors of dental students, trainees and interns had, on average, over 20 years’
experience (23.9 ± 9.9) as a clinician, and a broad range of experience as a supervisor
(10.4 ± 8.5).
• Training in supervision for supervisors of dental students, trainees and interns is typically
provided by the students’ training institution. Supervisors may also undertake formal and
informal training.
• In total, 19 current supervisors of dental students, trainees and interns indicated they had
undertaken formal supervision training. In addition, 19 supervisors indicated they had
undertaken some form of informal supervisor training.
• Placements for dental students, trainees and interns can vary from short-term to full-time
placements.
• Over three-quarters of supervisors of dental students, trainees and interns work in full-time
roles (77.4%). The time spent providing supervision varies from less than 5 hours per
• Half of current supervisors of dental students, trainees and interns indicated they are at
capacity, and could not take on further supervision.
• Over one-third (37.5%) of current supervisors of dental students, trainees and interns
indicated some capacity for additional supervision and over half of those not providing
supervision indicated interest and capacity to provide supervision.
• For current and non-current supervisors of dental students, trainees and interns, the major
factor influencing capacity to undertake supervision is the balance between service
delivery and teaching.
• ‘Clinical skills and knowledge’ were nominated as the most important core skill for
supervisors by 63% of supervisors of dental students, trainees and interns in dentistry.
56
5.1
OVERVIEW OF STUDENT, TRAINEE AND INTERN SUPERVISION IN DENTISTRY
LHDs and universities work together in the provision of supervision to dental students,
trainees and interns.
Interview responses indicate that, within the public health sector, supervision of dental students,
trainees and interns generally occurs in a clinic-based setting.
University students participate in regular half-day, clinic-based sessions where they are
supervised in groups of 6 to 8 students per supervisor. The supervisor will oversee and support
patient care during these sessions. Generally, this supervisor will be a registered dentist,
although circumstances do occur where the supervisor may be a provisionally registered dentist.
The universities and LHDs have a working relationship for the provision and funding of these
supervisors.
5.2
PROFILE OF SUPERVISORS OF DENTAL STUDENTS, TRAINEES AND INTERNS
5.2.1 Number of supervisors of dental students, trainees and interns
dental students, trainees and interns in NSW.
• 35 individuals who indicated they have provided supervision for dental students, trainees
and interns in the past 12 months (Figure 5.1).
• 6 dentistry professionals who indicated that they have not provided supervision for
students, trainees and interns in the past 12 months, but have provided supervision
previously (Figure 5.1); these people represent a potential additional source of
supervisors in NSW.
Figure 5.1: Dentistry professionals who are currently supervising, have previously supervised or
have never supervised dental students, interns and trainees (n=44)
40
35
30
Never
20
10
6
3
0
57
5.2.2 Location of current supervisors of dental students, trainees and interns
Supervisors of dental students, trainees and interns were identified in both metropolitan
and rural LHDs, as well as in training institutions.
Information about location of supervisors was provided by 29 of the survey respondents who
identified as providing supervision for dental students, trainees and interns. Of these:
• the highest number were from Western Sydney, Murrumbidgee and Southern NSW
(Table 5.1)
• no responses were received from Illawarra Shoalhaven, South Eastern Sydney, Northern
Sydney, Far West, Hunter New England and Northern NSW
• 1 response was received from a Specialist Health Network (Table 5.2)
• a small number were working in University or TAFE/other Vocational Education and
Training (VET) sectors (Table 5.3).
Table 5.1: Location of supervisors of dental students, trainees and interns in NSW, by LHD (n=25)
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
1
Far West
0
0
Hunter New England
0
1
Mid North Coast
2
Northern Sydney
0
Murrumbidgee
4
0
Northern NSW
0
1
Southern NSW
4
Sydney
3
Western NSW
2
Western Sydney
7
Total metropolitan
13
12
Table 5.2: Location of supervisors of dental students, trainees and interns in NSW, by Specialist
Health Network (n=1)
Number of
supervisors
Justice Health & Forensic Mental Health Network
0
1
0
Table 5.3: Location of supervisors of dental students, trainees and interns in NSW, by non-LHD
institution (n=3)
Institution type
Number of
supervisors
University
1
2
58
5.2.3 Work setting in which supervision is currently provided for dentistry
The most common work settings for supervisors of dental students, trainees and interns
identified in NSW were primary health care and community-based care.
Information about the setting of supervision was provided by 34 of the survey respondents who
identified as providing supervision for dental students, trainees and interns. Of these:
• just under half (44%) indicated that supervision is provided in a primary health care setting
(Table 5.4)
• a total of 8 (23.5%) dental respondents identified as providing supervision in a communitybased setting
• 2 (7.6%) dental supervisors identified as providing supervision in rural/remote settings
• ‘other’ settings, nominated by 9 respondents included: dental hospitals or clinics; TAFE;
and laboratory settings.
Table 5.4: Setting in which supervision of dental students, trainees and interns is provided (n=34)*
Supervisors
n
%
3
8.8
Aged care
3
8.8
Mental health
1
2.9
Primary health care
15
44.1
8
23.5
Rural remote care
2
5.9
Emergency
2
5.9
Hospital/ward based care
5
14.7
Other
9
26.5
Survey respondents were asked to identify if they also worked in a private setting, in addition to
their work in the public health settings listed in Table 5.4. Information was received from 31
dental supervisors. Of these, 11 indicated they also work within a private setting.
5.2.4 Demographics of supervisors of dental students, interns and trainees
The majority of supervisors of dental students, trainees and interns identified were
female and over 30 years of age. No supervisors of dental students, trainees and interns
were identified as being younger than 30 years of age.
Information about demographics of supervisors was provided by 31 of the survey respondents
who identified as providing supervision for dental students, trainees and interns. Of these:
• almost two-thirds (64.5%) were female (Figure 5.2)
• the majority were aged in their 30s (35.5%), 40s (22.6%) and 50s (35.5%) (Figure 5.3).
59
Figure 5.2: Gender of people providing supervision for dental students, trainees and interns in
NSW (n=31)
Male
Female
35.5%
64.5%
Figure 5.3: Age of people providing supervision to dental students, trainees and interns in NSW
(n=31)
40
35.5
20–29 years
35.5
35
30–39 years
40–49 years
% of respondents
30
50–59 years
25
22.6
60+ years
20
15
10
6.5
5
0
5.2.5 Recognition of the role of student, trainee and intern supervision in dentistry
The majority of supervisors of dental students, trainees and interns identified indicated
that supervision is a formal or expected part of their role. These roles are generally not
funded or partially funded.
Of the survey respondents who identified as providing supervision for dentistry students,
• over three-quarters (82.5%) indicated that supervision of students, trainees and interns is a
formally recognised part of their role (Figure 5.4)
• around one-third (34.5%) indicated they receive no funding for the provision of supervision
of students, trainees and interns; a further 37.5% indicated their role is partially funded
(Figure 5.5).
60
Information regarding role recognition and funding of supervisors in dentistry collected from the
electronic survey contrasted with interview feedback. An interview with a dentistry professional
involved in the supervision of dentistry students, trainees and interns suggested that this
requirement is generally not outlined formally in a dentistry professional’s job description but is
instead undertaken in goodwill.
“… as part of a statement of duties of a dentist working, at least in the public
sector …it’s not in their statement of duties that they have to deliver education.
It’s more an honorary type thing that they get asked to do.”
“If it is included in a job description it would be a very wiggly-worded, you know
somewhere to the extent you … would be willing to assist or participate in
teaching.”
% of respondents
Figure 5.4: Role definition for supervisors of dental students, trainees and interns in NSW (n=35)
100
90
80
70
60
50
40
30
20
10
0
Formal
Not formal
Unsure
82.5
14.3
5.7
Figure 5.5: Proportion of role funded for provision of supervision of dental students, trainees and
100
Not funded
% of respondents
90
Partially funded
80
Fully funded
70
Unsure
60
50
40
34.4
37.6
30
20
12.5
15.6
10
0
61
5.2.6 Approach to supervision of students, trainees and interns in dentistry
The most common approach to supervision of dental students, trainees and interns
nominated by current supervisors was direct supervision provided by a team of
supervisors, or by a single supervisor with a team of students. Interdisciplinary
supervision by dentistry professionals is uncommon.
Of the survey respondents who identified as providing supervision for dental students, trainees
and interns:
• the most common approaches to supervision nominated were a team approach and the
supervision of more than one trainee by one supervisor (62.9% and 28.6%, respectively)
(Table 5.5)
• provision of interdisciplinary supervision by dentistry professionals was uncommon (Figure
5.6); the breakdown of approaches to interdisciplinary supervision has not been provided
because numbers were so small.
Table 5.5: Approach to supervision of dental students, trainees and interns in NSW (n=35)*
Respondents
n
%
One-to-one
2
5.7
One to > one
10
28.6
22
62.9
2
5.7
Team approach
Other approach
†
*Respondents could nominate more than one approach
†
Managers who oversee or mentor student supervisors
Table 5.6: Type of supervision provided for dental students, trainees and interns in NSW (n=35)*
Respondents
n
%
24
68.6
12
34.3
18
51.4
12
34.3
Other role
1
2.9
62
Figure 5.6: Interdisciplinary supervision of students, interns and trainees by dentistry
Yes
19.4%
No
80.6%
5.2.7 Years of experience of supervisors of dental students, trainees and interns
Supervisors of dental students, trainees and interns identified in NSW had, on average,
over 20 years’ experience as a clinician and a broad range of experience as a supervisor.
and interns in NSW:
• the average number of years of experience as an dentistry professional was 23.9 ± 9.9
(Figure 5.7)
• the average number of years of experience in providing supervision to dental students,
trainees and interns was 10.4 ± 8.5.
Figure 5.7: Average years of experience as a dentistry professional (n=28) and supervisor of dental
students, trainees and interns (n=33)
40
Average years of experience as a clinician
Average years of experience as a supervisor
Number of years
30
23.9
20
10.4
10
0
63
5.2.8 Training in supervision of dental students, trainees and interns
Training in supervision for supervisors of dental students, trainees and interns is
typically provided by the students’ training institution. Supervisors may also undertake
formal and informal training.
One interview with a dentistry professional indicated that an orientation program is provided to
supervisors of students, trainees and interns by the university. This orientation program takes
half a day to complete, and is generally run after hours or on the weekend.
The university-run orientation program focuses on current clinical policies, rather than the skills
required to supervise and educate students.
“The university course is more directed at showing the supervisors what are the
… current clinical policies and it’s largely clinical based, rather than mentor,
education based. So it’s more in clinical knowledge …”
In addition to the university-run orientation program, the interview participant indicated that an
LHD-based program does exist to educate supervisors of dental students, trainees and interns.
The day-long program focuses on the education and mentoring of adults, as well as how to
provide appropriate feedback and assessment.
and interns:
• 19 respondents indicated they had undertaken some form of formal training in supervision
(Table 5.7)
and Assessment
• 19 respondents indicated they had undertaken some form of informal training in
supervision (Table 5.8)
• the most common form of informal training was a University-delivered program.
One respondent indicated that dentistry qualifications include a component of training in
supervision, one was in the process of completing a qualification and one reported having
completed discipline-specific training in supervision offered by a professional college.
Table 5.7: Formal training in supervision undertaken by supervisors of dental students, trainees
and interns in NSW (n=19)*
Respondents
n
%
12
63.2
4
21.1
Graduate diploma
2
10.5
Master’s
4
21.1
Doctorate
3
15.8
*Respondents could choose more than one qualification
64
Table 5.8: Informal training in supervision undertaken by supervisors of dental students, trainees
†
Respondents
n
%
6
31.6
LHD-run course
2
10.5
5
26.3
External course
2
10.5
University-delivered program (facilitator training)
12
63.2
†Comments fields indicate that many respondents included qualifications that have a component (e.g. one subject
on supervision
Of dentistry respondents who indicated they had not provided supervision for students, trainees
and interns in the past 12 months:
• 5 indicated that they had undertaken some form of formal training in supervision (Table
5.9)
• the most common form of supervision training undertaken was a Graduate certificate
• 2 indicated that they had undertaken some form of informal training in supervision (Table
5.10)
• the most common form of informal training undertaken was a workshop or seminar run by
the LHD or external to the LHD.
Table 5.9: Formal training in supervision undertaken by non-supervising dentistry professionals
(n=5)*
Respondents
n
%
2
40.0
3
60.0
Graduate diploma
1
20.0
Master’s
0
0.0
Doctorate
0
0.0
65
Table 5.10: Informal training in supervision undertaken by non-supervising dentistry professionals
(n=2)
Respondents
n
%
1
50.0
LHD-run course
0
0
1
50.0
University-delivered program
0
0.0
5.3
CAPACITY FOR SUPERVISION OF DENTAL STUDENTS, TRAINEES AND INTERNS
5.3.1 Duration of dental student, trainee and intern placements
Placements for dental students, trainees and interns can vary from short-term to full-time
placements.
Survey responses from individuals who identified as providing supervision for students, trainees
and interns in dentistry illustrated that the duration of placements for students, trainees and
interns is varied, with placement duration ranging from short-term to full-time. (Table 5.11)
Table 5.11: Typical duration of dental student, trainee and intern placements in NSW (n=32)
Respondents
n
%
8
25
7
21.8
9
28.1
10
31.3
7
21.8
*Respondents could choose more than one placement duration
5.3.2 Time spent supervising dental students, trainees or interns
The majority of supervisors of dental students, trainees and interns typically work in fulltime roles. The time spent providing supervision varies from less than 5 hours per week
to more than 30 hours per week.
interns in dentistry:
• over three-quarters (77.4%) were working in full-time roles (more than 30 hours per week)
(Table 5.12)
• almost one-third indicated they provide less than 5 hours of supervision per week (Table
5.13)
• over 17% of dentistry professionals indicated they provide more than 30 hours of
supervision per week (Table 5.13)
66
dental students, trainees and interns in NSW (n=31)
Respondents
n
%
<15
1
3.2
15–20
2
6.5
20–25
2
6.5
25–30
2
6.5
30+
24
77.4
Table 5.13: Average number of hours per week spent supervising dental students, trainees and
Respondents
n
%
<1–5
10
29.4
5–10
6
17.6
10–15
5
14.7
15–20
4
11.8
20–25
2
5.9
25–30
1
2.9
30+
6
17.6
Half of current supervisors of dental students, trainees and interns indicated they are at
Over one-third of current supervisors of dental students, trainees and interns indicated
some capacity for additional supervision, and over half of those not providing
Current supervisors
interns in dentistry:
• half (50%) indicated they were at capacity, and could not take on further supervision
(Table 5.14)
• over one-third (37.5%) indicated they had some capacity for additional supervision.
67
Table 5.14: Supervision capacity for current supervisors of dental students, trainees and interns in
NSW (n=32)
Respondents
n
%
At capacity
16
50.0
Some capacity
12
37.5
Underutilised
3
9.4
Other*
1
3.1
*Comments provided as ‘other’ responses are reported together with factors impacting on capacity to undertake
supervision in Section 5.3.4
Of survey respondents who indicated they had not provided supervision for dental students,
trainees and interns in the past 12 months:
• over half (55.6%) indicated they had capacity and interest in undertaking supervision
(Table 5.15).
Table 5.15: Supervision capacity for dentistry professionals not currently providing supervision of
Level of capacity
Respondents
n
%
No capacity
3
33.3
5
55.6
Not interested
0
0
Unsure
1
11.1
For current and non-current supervisors of dental students, trainees and interns, the
major factor influencing capacity to undertake supervision is the balance between service
Current supervisors
and interns:
• feeling confident in supervising others was nominated as a factor for one-quarter of
respondents.
68
Table 5.16: Factors affecting capacity for supervision of dental students, trainees and interns in
NSW for current supervisors (n=32)*
Respondents*
n
%
20
62.5
9
28.1
13
40.6
7
21.9
4
12.5
6
18.8
Access to training
6
18.8
8
25.0
8
25.0
Other
†
*Respondents could nominate more than one factor affecting capacity. Percentages are based on respondents not
responses.
†
Themes arising in the ‘other’ responses are reported together with factors that affect their capacity to increase the
amount of supervision they are undertaking below
The following were identified by dentistry staff who are currently providing supervision as factors
• lack of dedicated time
• access to resources
• lack of financial incentives
• improved communications with/from training institutions
• level of student skills.
Information about barriers to supervision was identified for the 8 dentistry professionals who did
not indicate a lack of interest in providing supervision for students, trainees and interns:
• the most common barriers identified were the balance between service delivery and
teaching, and the access to training (each nominated by 25.0% of respondents) (Table
5.17)
• ‘other’ factors were identified by 3 respondents; these related to lack of opportunity or need
for supervision in rural and remote settings.
69
Table 5.17: Factors affecting capacity for supervision of dental students, trainees and interns in
NSW for those not providing supervision (n=8)*
Respondents
n
%*
teaching
2
25.0
0
0.0
1
12.5
0
0.0
0
0.0
0
0.0
1
12.5
Access to training
2
25.0
0
0.0
1
12.5
3
37.5
Other
†
responses.
†‘Other’ reasons included being unable to attend training because it would result in an unattended clinic; and not
working in a health service
5.4
CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR DENTAL STUDENTS,
TRAINEES AND INTERNS
The most important core skill nominated by supervisors of dental students, trainees and
interns was ‘clinical skills and knowledge’. The least important skill was ‘remediation of
underperforming students’.
and interns, 28 respondents attempted to rank the seven core skill of a supervisor. For these
respondents:
• ‘clinical skills and knowledge’ was identified as the most important core skill by 63% (n=17)
of respondents (Figure 5.8), a further 15% of respondents ranked it as the second most
important skill
• ‘adult teaching and learning skills’ was identified as the most important core skill by 24%
(n=6) of respondents, a further 16% of respondents ranked it as the second most
important skill
respondents, a further 18% of respondents ranked it as the second most important skill
• ‘remediation of underperforming students’ was identified as the least important of the 7
core skills by 27% (n=7) of respondents (Figure 5.9).
70
Figure 5.8 Core skills ranked as most important (rank=1) for supervisors of dental students,
100
90
% of respondents
80
70
63
60
50
40
30
24
20
14
10
8
4
0
0
0
Figure 5.9: Core skills ranked as least important (rank=7) by supervisors of dental students,
100
90
% of respondents
80
70
60
50
40
27
30
20
20
11
10
13
8
11
4
0
A total of 8 survey respondents who indicated they had not provided supervision for dental
students, trainees and interns in the past 12 months attempted to rank the core skills of a
• ‘clinical skills and knowledge’ and ‘adult teaching and learning skills’ were identified as the
most important core skills (i.e. a rank of 1 or 2) by a total of 4 respondents
• ‘self-evaluation and reflection’ and ‘remediation of poorly performing students’ were
identified as the least important core skills (i.e. a rank of 6 or 7) by a total of 4 of
respondents.
71
Table 5.19: Core skills required for supervisors, as ranked by people not currently providing
supervision of dental students, trainees and interns*
Rank 1–2
Rank 3–5
Rank 6–7
No. of
respondents
No. of
respondents
No. of
respondents
Clinical skills and knowledge (n=6)
4
4
0
(n=6)
4
4
0
(n=6)
1
1
0
0
0
3
Self-evaluation and reflection (n=7)
1
1
4
students (n=8)
2
2
4
3
3
1
72
6. PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND
INTERNS IN MEDICINE
Key findings
• Approaches to supervision of medical students, trainees and interns vary by setting and
location.
medical students, trainees and interns in NSW.
• Supervisors of medical students, trainees and interns were identified in all Local Health
Districts (LHDs) and Specialist Health Networks in NSW.
• The most common work settings for supervisors of medical students, trainees and interns
identified were hospital/ward-based care (54%) and emergency (23%).
• The majority of supervisors of medical students, trainees and interns identified were male
(55.7%) and over 40 years of age (63.4%).
• The majority of supervisors of medical students, trainees and interns identified indicated
that supervision is a formal or expected part of their role (82.5%), but is not specifically
funded (63.6%).
• The most common approach to supervision of medical students, trainees and interns
nominated by current supervisors was direct supervision (83.3%), provided by a team of
supervisors (80.1%).
• Supervisors of medical students, trainees and interns identified had a broad range of years
of experience both as a clinician (19.8 ± 11) and as a supervisor (13.3 ± 9.5).
• While supervision training programs do exists, they are not a requirement for the
supervision of medical students, trainees and interns. Training programs may be offered
by a university, a professional college or an LHD.
• In total, 63 current supervisors of medical students, trainees and interns indicated they had
undertaken formal supervision training. In addition, 165 supervisors indicated they had
undertaken some form of informal supervisor training.
• Placements for medical students, trainees and interns tend to be medium to longer-term (1
week 6 months) (64.2%).
• The majority of supervisors of medical students, trainees and interns typically work in fulltime roles (84.5%). The time spent providing supervision varies from less than 5 hours
per week (35.2%) to more than 30 hours per week (7%).
• Almost two-thirds (65.9%) of supervisors of medical students, trainees and interns
indicated that they are at capacity, and could not take on further supervision.
• Around one-quarter of current supervisors of medical students, trainees and interns
indicated some capacity (26.2%) for additional supervision and over half of those not
providing supervision (57.7%) indicated interest and capacity to provide supervision.
• For current and non-current supervisors of medical students, trainees and interns, the
delivery and teaching (86.5% and 38.9%, respectively).
• The most important core skill nominated by supervisors of medical students, trainees and
interns was ‘clinical skills and knowledge’ (39%). The least important skill was
‘remediation of underperforming students’ (28%).
73
6.1
OVERVIEW OF MEDICAL STUDENT, TRAINEE AND INTERN SUPERVISION
Approaches to supervision of medical students, trainees and interns vary by setting and
location.
The approach to supervision of medical students, trainees and interns is dependent on the
setting in which supervision is provided and the location of clinical material.
The structure of supervision of medical students, trainees and interns is coordinated by a
working relationship between universities and hospital sites.
Interview responses highlighted that, in general, universities have established infrastructure in
place at their associated hospital sites to coordinate the placement of their medical students,
trainees and interns. This infrastructure is inclusive of medical educators, placement
coordinators and administration staff. The placement and supervision of students, trainees and
interns is coordinated by these staff. Staff have working relationships with the clinicians at each
site, who ultimately provide the student supervision.
Medical students are typically assigned to a consultant, who oversees the student, however,
point of care supervision is provided by all medical staff within a department. Generally, a
medical student will be buddied with a registrar on a day-to-day basis.
A unique aspect of the supervision of medical students, trainees and interns is the need to
access relevant clinical material.
“If you’re trying to teach a certain particular disease, or a certain particular system
… there is a requirement to have people with that problem at the time when the
teacher is there and the students are there.”
Coordination of this process requires the support of administration staff and flexibility within
student placements.
“We also obviously encourage some independence of our students in their
learning activities so they may be nominally attached in one ward, but in fact will
be free to move between places.”
6.2
PROFILE OF SUPERVISORS OF MEDICAL STUDENTS, TRAINEES AND INTERNS
6.2.1 Number of supervisors of medical students, trainees and interns
medical students, trainees and interns in NSW.
• 363 individuals who indicated they have provided supervision for medical students,
trainees and interns in the past 12 months (Figure 6.1).
• 21 medical professionals who indicated they have not provided supervision for students,
trainees and interns in the past 12 months, but have provided supervision previously
(Figure 6.1). These people represent a potential additional source of supervisors in NSW.
74
Figure 6.1: Medical professionals who are currently supervising, have previously supervised or
have never supervised students, interns and trainees (n=397)
400
363
350
300
Never
250
Unsure
200
150
100
50
21
12
1
0
6.2.2 Location of current supervisors of medical students, trainees and interns
Supervisors of medical students, trainees and interns were identified in all LHDs and
Specialist Health Networks in NSW.
Information about location was provided by 339 survey respondents who identified as providing
supervision for medical students, trainees and interns. Of these:
• the highest number in metropolitan areas were from South Eastern Sydney, Northern
Sydney and Sydney LHDs (Table 6.1)
• the highest number in a rural or regional area were from Hunter New England LHD (Table
6.1)
• the lowest number were from Western NSW, Far West and Murrumbidgee
• a total of 47 were working in one of the Specialist Health Networks (Table 6.2)
• a small number were working in the university sector (Table 6.3).
Table 6.1: Location of supervisors of medical students, trainees and interns in NSW, by LHD
(n=282)
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
6
Far West
3
23
Hunter New England
34
8
Mid North Coast
7
Northern Sydney
40
Murrumbidgee
4
48
Northern NSW
13
19
Southern NSW
7
Sydney
37
Western NSW
2
Western Sydney
31
Total metropolitan
212
70
75
Table 6.2: Location of supervisors of medical students, trainees and interns in NSW, by Specialist
Health Network (n=47)
Number of
supervisors
8
25
14
Table 6.3: Location of supervisors of medical students, trainees and interns in NSW, by non-LHD
institution (n=10)
Institution type
Number of
supervisors
University
10
TAFE or other Vocational Education and Training (VET)
college
0
6.2.3 Work setting in which supervision is currently provided for medicine
The most common work settings for supervisors of medical students, trainees and
interns identified in NSW were hospital/ward-based care and emergency.
Of the survey respondents who identified as providing supervision for medical students, trainees
and interns (Table 6.4):
• over half (54%) indicated that supervision is provided in a hospital or ward-based setting
• a total of 18 (5%) medical supervisors identified as providing supervision in rural/remote
settings
• a total of 83 (23%) medical respondents identified as providing supervision in an
emergency setting
• ‘other’ settings, nominated by 94 (26%) respondents included: specialty contexts such as
surgery, intensive care, anaesthesia, addiction medicine, and oncology; a range of
outpatient settings; Aboriginal Medical Services; clinical research; and universities.
Table 6.4: Setting in which supervision of medical students, trainees and interns is provided
(n=361)*
Supervisors
n
%
21
5.8
Aged care
22
6.1
Mental health
31
8.6
Primary health care
40
11.1
29
8.0
Rural remote care
18
5.0
Emergency
83
23.0
195
54.0
Other
94
26.0
76
medical supervisors. Of these, 44.3% indicated they also work within a private setting.
6.2.4 Demographics of supervisors of medical students, interns and trainees
The majority of supervisors of medical students, trainees and interns identified in NSW
were male and over 40 years of age.
and interns:
• just over half (55.7%) were male (Figure 6.5)
• the majority were aged in their 40s (33%) and 50s (30.4%) (Figure 6.6).
Figure 6.5: Gender of people providing supervision for medical students, trainees and interns in
NSW (n=309)
Male
Female
44.3%
55.7%
Figure 6.6: Age of people providing supervision to medical students, trainees and interns in NSW
(n=309)
50
20–29 years
45
30–39 years
% of respondents
40
40–49 years
33
35
50–59 years
30.4
60+ years
30
25
21.7
20
15
10.4
10
5
4.5
0
77
6.2.5 Recognition of the role of student, trainee and intern supervision in medicine
The majority of supervisors of medical students, trainees and interns identified in NSW
indicated that supervision is a formal or expected part of their role, but is not specifically
funded.
and interns:
• the majority (82.5%) indicated that supervision of students, trainees and interns is a
• almost two-thirds (63.6%) indicated they receive no funding for the provision of supervision
of students, trainees and interns (Figure 6.8).
Findings from the electronic survey were supported by interview responses, which suggested
that supervision of students, trainees and interns is a formally recognised part of a medical
professional’s role, and as such is included in the person’s job description. The culture of
medicine is such that providing supervision to junior staff members is an expected part of a
medical professional’s role and as such is undertaken in goodwill.
“If you’re appointed to a hospital that is part of a Local Health District in general
and there is a requirement for people to teach, it's something that’s in the
contract.”
“ … we still rely on the goodwill of the people and also the goodwill of the system
that will permit a certain amount of time to be taken in training the next generation
of practitioners.”
Figure 6.7: Role definition for supervisors of medical students, trainees and interns in NSW
(n=360)
100
90
Formal
Not formal
Unsure
82.5
% of respondnets
80
70
60
50
40
30
20
10
13.1
4.4
0
78
Figure 6.8: Proportion of role funded for provision of supervision of medical students, trainees and
% of respondents
100
Not funded
90
Partially funded
80
Fully funded
70
Unsure
63.6
60
50
40
30
22.2
20
11.3
10
2.8
0
6.2.6 Approach to supervision of students, trainees and interns in medicine
The most common approach to supervision of medical students, trainees and interns
nominated by current supervisors was direct supervision, provided by a team of
supervisors.
and interns:
• the most common approach to supervision nominated was a team approach (nominated
by 80.1% of respondents) (Table 6.5)
• direct supervision was the most common type of supervision, identified by 87.4% of
respondents (Table 6.6)
• interdisciplinary supervision was identified as being used by just over one-quarter (29.7%)
of medical respondents (Figure 6.9)
• the most common type of interdisciplinary supervision identified was informal ‘on-the-job’
supervision (Table 6.7).
Table 6.5: Approach to supervision of medical students, trainees and interns in NSW (n=361)*
Respondents
n
%
One-to-one
29
8.0
One to > one
51
14.1
289
80.1
26
7.2
Team approach
Other approach
†
†
Some respondents indicated that all of the approaches are used, depending on the context and availability of other
staff. Others appeared to provide supervision on an ad hoc basis, as requested. It was noted that different specialties
have different requirements.
79
Table 6.6: Type of supervision provided for medical students, trainees and interns in NSW (n=350)*
Respondents
n
%
306
87.4
130
37.1
206
58.9
153
43.7
Other role
14
4.0
Figure 6.9: Interdisciplinary supervision of students, interns and trainees by medical professionals
in NSW (n=317)
2.5%
Yes
No
29.7%
Unsure
67.8%
Table 6.7: Type of interdisciplinary supervision provided for students, trainees and interns by
medical professionals in NSW (n=87)
Type of supervision
Respondents
n
%
19
21.8
64
73.6
0
0.0
Other
4
4.6
80
6.2.7 Years of experience of supervisors of medical students, trainees and interns
Supervisors of medical students, trainees and interns identified in NSW had a broad
range of years of experience both as a clinician and as a supervisor.
and interns in NSW:
• the average number of years of experience as an medical professional was 19.8 ± 11
(Figure 6.10)
• the average number of years of experience in providing supervision to medical students,
trainees and interns was 13.3 ± 9.5.
Figure 6.10: Average years of experience as a clinician (n=305) and supervisor of medical
35
Average years of experience as a
clinician
supervisor
30
Number of years
25
19.8
20
15
13.3
10
5
0
6.2.8 Training in supervision of medical students, trainees and interns
While supervision training programs do exist, they are not a requirement for the
supervision of medical students, trainees and interns. Training programs may be offered
by a university, a professional college or an LHD.
Interview responses indicated that, while some training programs do exist for supervisors of
medical students, trainees and interns, completion of such programs is not a requirement.
Clinical training and experience is considered sufficient.
Existing training courses identified through interviews included university-run orientation
programs, accreditation programs run through professional colleges, and the ‘Teaching on the
run’ program.
University-run programs focus on the student’s curriculum and assessment.
“…we do try to have sessions to tell people, particularly when there are changes
in curriculum or when we particularly want something being done in one way, or
we’re looking at implementation of a newer assessment tool.”
81
Accreditation programs run through professional colleges are undertaken by those medical
professionals who wish to provide supervision as an accredited educator on behalf of the
professional college. The programs are typically targeted at the supervisors of individuals at a
prevocational or registrar level.
“Certainly we have those requirements for people to become supervisors at a
prevocational level and a registrar level and that’s through our standards that we
have.”
Interview feedback suggested that the ‘Teaching on the run’ program is well recognised by
medical professionals.
and interns:
• the most common form of training undertaken was a Master’s degree
• 165 medical professionals indicated they had undertaken some form of informal training in
• the most common form of informal training undertaken was an external seminar or
workshop.
Some respondents reported having completed discipline-specific training in supervision offered
by professional colleges, including the Royal Australasian College of Surgeons, Royal
Australasian College of Physicians, Royal Australian and New Zealand College of Psychiatrists
and Australian and New Zealand College of Anaesthetists.
Table 6.8: Formal training in supervision undertaken by supervisors of medical students, trainees
†
Respondents
n
%
6
9.5
18
28.6
Graduate diploma
11
17.5
Master’s
21
33.3
Doctorate
14
22.2
*Respondent could choose more than one qualification
† Comments fields indicate that many respondents included qualifications that have a component (e.g. one subject
on supervision
82
Table 6.9: Informal training in supervision undertaken by supervisors of medical students, trainees
Respondents
n
%
22
13.3
LHD-run course
10
6.1
95
57.6
External course
35
21.2
60
36.4
Of the survey respondents who indicated they had not provided supervision for medical
• the most common form of supervision training undertaken was a Master’s degree
• 5 indicated they had undertaken some form of informal training in supervision (Table 6.11)
• the most common form of informal training undertaken was an external workshop or
seminar.
Table 6.10: Formal training in supervision undertaken by non-supervising medical professionals
(n=11)*
Number of
respondents
1
3
Graduate diploma
3
Master’s
6
Doctorate
1
*Respondents could choose more than one qualification; % not provided because of low numbers
Table 6.11: Informal training in supervision undertaken by non-supervising medical professionals
(n=5)*
1
LHD-run course
0
3
2
*Respondents could choose more than one qualification; % not provided because of low numbers
83
6.3
CAPACITY FOR SUPERVISION OF STUDENTS, TRAINEES AND INTERNS IN
MEDICINE
6.3.1 Duration of medical student, trainee and intern placements
Placements for medical students, trainees and interns tend to be medium to longer-term
(1 week – 6 months).
Survey responses from individuals who identified as providing supervision for medical students,
trainees and interns illustrated that the duration of placements for medical students, trainees and
interns is varied. Long-term placements of 1–6 months were reported most commonly, closely
followed by medium-term placements of 1 week to 1 month (Table 6.12).
Table 6.12: Typical duration of medical student, trainee and intern placements in NSW (n=318)*
Respondents
n
%
102
32.1
180
56.6
204
64.2
86
27.0
68
21.4
6.3.2 Time spent supervising medical students, trainees or interns
The majority of supervisors of medical students, trainees and interns typically work in
full-time roles. The time spent providing supervision varies from less than 5 hours per
interns in medicine:
• the majority were working in full-time roles (more than 30 hours per week) (Table 6.13)
• more than one-third (35.2%) indicated they provide less than 5 hours of supervision per
week (Table 6.14)
• fewer than 7% of medical professionals indicated they provide 30 or more hours of
supervision per week.
medical students, trainees and interns in NSW (n=309)
Respondents
n
%
<15
7
2.3
15–20
9
2.9
20–25
17
5.5
25–30
15
4.9
30+
261
84.5
84
Table 6.14: Average number of hours per week spent supervising medical students, trainees and
Respondents
n
%
<1–5
123
35.2
5–10
114
32.7
10–15
40
11.5
15–20
28
8.0
20–25
13
3.7
25–30
9
2.6
30+
22
8.8
Almost two-thirds of supervisors of medical students, trainees and interns indicated they
are at capacity, and could not take on further supervision.
Around one-quarter of current supervisors of medical students, trainees and interns
indicated some capacity for additional supervision, and over half of those not providing
Current supervisors
and interns:
• almost two-thirds (65.9%) indicated they were at capacity and could not take on further
• just over one-quarter (26.2%) indicated they had some capacity for additional supervision
• most ‘other’ comments provided descriptions of supervisors feeling at or overcapacity.
“Beyond the capacity to safely supervise all the interns and medical students to
the extent I would like each shift.”
“At times I am overloaded with my own work, unhelpful as a supervisor.”
Table 6.15: Supervision capacity for current supervisors of medical students, trainees and interns
in NSW (n=328)
Respondents
n
%
At capacity
216
65.9
Some capacity
86
26.2
Underutilised
11
3.4
Other
15
4.6
85
Of survey respondents who indicated they had not provided supervision for medical students,
trainees and interns in the past 12 months:
• over half (57.7%) indicated they had capacity and interest in undertaking supervision
(Table 6.16)
Table 6.16: Supervision capacity for medical professionals not currently providing supervision of
Respondents
n
%
No capacity
8
30.8
15
57.7
Not interested
1
3.8
Unsure
2
7.7
For current and non-current supervisors of medical students, trainees and interns, the
Current supervisors
and interns:
• other high-rating factors included staff to patient ratios (35.8%) and incentives for
supervisors (26.9%)
• dealing with underperforming students was nominated as a factor by 14.4% of
respondents.
86
Table 6.17: Factors affecting capacity for supervision of medical students, trainees and interns in
NSW for current supervisors (n=327)*
Respondents*
n
%
283
86.5
73
22.3
117
35.8
40
12.2
88
26.9
40
12.2
Access to training
51
15.6
41
12.5
47
14.4
Other
†
responses.
†Themes arising in the ‘other’ responses are reported together with factors that affect capacity to increase the amount
of supervision being undertaken
The following were identified by medical staff who are currently providing supervision as factors
• lack of dedicated time for supervision and training in supervision
• insufficient staffing
• lack of communication with teaching institutions
• lack of access to facilities such as dedicated office space or telemedicine
• lack of formal and financial recognition
• lack of management support
• administrative requirements.
Information about barriers to supervision was identified for the 18 medical professionals who did
not indicate a lack of interest in providing supervision for students, trainees and interns:
(nominated by 38.9% of respondents) (Table 6.18)
• ‘other’ factors were identified by 27.8% of respondents; these included age and the context
in which they work.
87
Table 6.18: Factors affecting capacity for supervision of medical students, trainees and interns in
NSW for those not providing supervision (n=18)*
Respondents*
n
%
teaching
7
4
22.2
2
11.1
3
16.7
2
11.1
2
11.1
3
16.7
Access to training
1
5.6
2
11.1
0
0
5
27.8
†
Other
38.9
responses.
† Themes arising under ‘other’ responses are reported together with factors that would help improve capacity to
undertake supervision
The following were identified by medical staff who are not currently providing supervision as
factors that would help improve their capacity to provide supervision:
• dedicated time
• increased staffing levels
• backfill for positions while providing supervision
• financial incentives
• training
• guidelines for supervision.
6.4
CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR MEDICAL STUDENTS,
TRAINEES AND INTERNS
The most important core skill nominated by supervisors of students, trainees and interns
in medicine was ‘clinical skills and knowledge’. The least important skill was ‘remediation
of underperforming students’.
88
and interns:
• ‘clinical skills and knowledge’ was identified as the most important core skill by 39%
(n=105) of respondents (Figure 6.11), a further 21% (n=56) of respondents ranked it as
the second most important skill
respondents, a further 18% (n=54) of respondents ranked it as the second most
important skill.
• ‘adult teaching and learning skills’ was identified as the most important core skill by 21%
(n=53) of respondents, a further 23% (n=59) of respondents ranked it as the second
most important skill
Figure 6.11 Core skills ranked as most important (rank=1) for supervisors of medical students,
% of respondents
100
90
80
70
60
50
40
39
30
24
21
20
10
10
2
5
6
0
89
Figure 6.12: Core skills ranked as least important (rank=7) by supervisors of medical students,
100
90
% of respondents
80
70
60
50
40
28
30
20
10
17
14
9
10
8
3
0
A total of 21 survey respondents who indicated they had not provided supervision for medical
students, trainees and interns in the past 12 months attempted to rank the core skills of a
• ‘clinical skills and knowledge’ and ‘adult teaching and learning skills’ were identified as the
most important core skills (i.e. a rank of 1 or 2) by over half of respondents (Table 6.19)
• ‘appraisal and assessment’ was identified as the least important core skill (i.e. a rank of 6
or 7) by 41.2% of respondents.
Table 6.19: Core skills required for supervisors, as ranked by people not currently providing
supervision of medical students, trainees and interns*
Rank 1–2
Rank 3–5
Rank 6–7
% of respondents
% of respondents
% of respondents
52.6
31.6
15.8
(n=19)
52.6
31.6
15.8
(n=18)
27.8
44.4
27.8
17.6
41.2
41.2
(n=21)
19.0
66.7
14.3
students (n=20)
5.0
55.0
40.0
38.1
33.3
28.6
90
91
7.
PROFILE OF SUPERVISORS OF STUDENTS AND TRAINEES IN
MIDWIFERY
This chapter refers to ‘students and trainees’ as opposed to ‘students, trainees and interns’.
Key findings
• Approaches to supervision of students and trainees in midwifery vary by setting and
location.
midwifery students and trainees in NSW.
• Supervisors of midwifery students and trainees were identified in both metropolitan and
regional Local Health Districts (LHDs).
• The most common work setting for supervisors of midwifery students and trainees
identified was hospital/ward-based care (76.5%).
• The majority of supervisors of midwifery students and trainees identified were female
(95.6%) and over 40 years of age (88.8%).
• The majority of supervisors of midwifery students and trainees identified indicated that
supervision is an expected part of their role (78.4%), but is not specifically funded
(43.5%).
• The most common approach to supervision of midwifery students and trainees nominated
by current supervisors was direct supervision (83.3%), provided by a team of supervisors
(70.6%).
• Supervisors of midwifery students and trainees identified had a broad range of years of
experience both as a clinician (21.3 ± 9.4 years) and as a supervisor (12.2 ± 8.8 years).
• Supervisors of midwifery students and trainees often undertake a preceptor training
program, offered locally by site. Midwifery professionals may also undertake other formal
or informal training.
• A total of 19 supervisors of midwifery students indicated they had undertaken a formal
training course in supervision. A further 25 supervisors indicated they had undertaken an
informal training course in supervision.
• Placements for midwifery students and trainees are varied, ranging from short-term
placements of less than one week, to full-time, 12-month placements.
• The majority of supervisors of midwifery students and trainees typically work in full-time
roles. The time spent providing supervision varies from less than 5 hours per week
(16.7%) to more than 30 hours per week (10.4%).
• More than half (53.2%) of supervisors of midwifery students and trainees indicated they
are at capacity, and could not take on further supervision.
• Around one-third (36.2%) of current supervisors of midwifery students and trainees
indicated some capacity for additional supervision and a total of 7 midwifery
professionals not providing supervision indicated interest and capacity to provide
supervision.
• For current and non-current supervisors of midwifery students and trainees, the major
• The most important core skill nominated by supervisors of students and trainees in
midwifery was ‘clinical skills and knowledge’ (57%). The least important skill was
92
‘remediation of underperforming students’ (41%).
7.1
OVERVIEW OF STUDENT AND TRAINEE SUPERVISION IN MIDWIFERY
Approaches to supervision of students and trainees in midwifery vary by setting and
location.
Midwifery is unique in that a high number of midwifery students and trainees are registered
nurses, who work in a nursing capacity within a midwifery setting while they study. In addition,
undergraduate midwifery students are generally attached to one facility for the duration of their 3
year degree.
Interview responses indicate that the supervision of midwifery students and trainees is provided
by registered midwives, at the point of patient care, on a one-to-one supervisor to student ratio.
“… Say you had four students placed on a unit and you had four nurses or
midwives working that morning shift, usually each one would get a student to
work with them for the day.”
In addition to point-of-care supervision, a clinical educator may oversee the supervision of
midwifery students and trainees, at times demonstrating procedures or identifying clinically
relevant material for a group of students. The clinical educator is also a registered midwife.
Provision of supervision in midwifery involves both the supervision of active learning that occurs
at the point of care, as well as the guidance of a reflective process following clinical activities.
“We work on looking at clinical activities that you have been engaged in or
interactions and then analysing them to really understand what you did and why
you did it and what you were thinking and why you were thinking that and how
your thoughts impacted on the provision of care…”
Reflection can relate to all aspects of care, from technical procedures to emotional support
provided to the patient. Reflective supervision aims to enable students to understand their
actions and, if required, change their future practice.
7.2
PROFILE OF SUPERVISORS OF MIDWIFERY STUDENTS AND TRAINEES
7.2.1 Number of supervisors of midwifery students and trainees
midwifery students and trainees in NSW.
• 51 individuals who indicated they have provided supervision for midwifery students and
trainees in the past 12 months (Figure 7.1)
• 6 midwifery professionals who indicated they have not provided supervision for students
and trainees in the past 12 months, but have provided supervision previously (Figure
7.2); these people represent a potential additional source of supervisors in NSW.
93
Figure 7.1: Midwifery professionals who are currently supervising, have previously supervised or
have never supervised students and trainees (n=63)
60
51
50
Never
Unsure
40
30
20
10
6
6
0
7.2.2 Location of current supervisors of midwifery students and trainees
Supervisors of midwifery students and trainees were identified in both metropolitan and
regional LHDs.
Of the survey respondents who identified as providing supervision for midwifery students and
trainees:
• the highest number were from South Eastern Sydney, Northern Sydney and Mid North
Coast (Table 7.1)
• no supervisors were identified in South Western Sydney and Northern NSW
• no supervisors were identified in Specialist Health Networks or educational institutions
Table 7.1: Location of supervisors of midwifery students and trainees in NSW, by LHD (n=44)
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
7
Far West
2
1
Hunter New England
1
1
Mid North Coast
5
Northern Sydney
6
Murrumbidgee
1
10
Northern NSW
0
0
Southern NSW
1
Sydney
4
Western NSW
1
Western Sydney
4
Total metropolitan
33
11
94
7.2.3 Work setting in which supervision is currently provided for midwifery students and
trainees
The most common work setting for supervisors of midwifery students and trainees
identified in NSW was hospital/ward-based care.
trainees:
• over three-quarters (76.5%) indicated that supervision is provided in a hospital or wardbased setting (Table 7.2)
• a total of 7 (13.7%) midwifery supervisors identified as providing supervision in both
primary and community- based health care
• ‘other’ settings, nominated by 10 (19.6%) respondents, related to specifics regarding the
type of midwifery services across antenatal, delivery, neonatal, and special care
practices; one respondent was a member of a midwifery group practice.
Table 7.2: Setting in which supervision of midwifery students and trainees is provided (n=51)*
Supervisors
n
%
0
0.0
Aged care
0
0.0
Mental health
0
0.0
Primary health care
7
13.7
7
13.7
Rural remote care
1
2.0
Emergency
1
2.0
39
76.5
Other
10
19.6
midwifery supervisors. Of these, 17.8% indicated they also work within a private setting.
7.2.4 Demographics of supervisors of midwifery students and trainees
The majority of supervisors of midwifery students and trainees identified in NSW were
female and over 40 years of age.
trainees:
• the vast majority (95.6%) were female (Figure 7.2)
• the majority were aged in their 40’s (44.4%) and 50’s (44.4%) (Figure 7.3).
95
Figure 7.2: Gender of people providing supervision for midwifery students and trainees in NSW
(n=45)
4.4%
Male
Female
95.6%
Figure 7.3: Age of people providing supervision to midwifery students and trainees in NSW (n=45)
50
44.4
% of respondents
45
44.4
20–29 years
30–39 years
40
40–49 years
35
50–59 years
60+ years
30
25
20
15
10
5
4.4
6.7
0
7.2.5 Recognition of the role of student and trainee supervision in midwifery
The majority of supervisors of midwifery students and trainees identified in NSW
indicated that supervision is a formal or expected part of their role, but is not specifically
funded.
trainees:
• over three-quarters (78.4%) indicated that supervision of students and trainees is a
• just under half (43.5%) of supervisors indicated they receive no funding for the provision of
supervision of students and trainees (Figure 7.5).
These survey results are supported by interview responses which suggested that supervision of
students and trainees is a formally recognised part of a midwifery professionals role, in that it is
96
included in the job description of a midwife. The provision of supervision is covered under the
Australian Midwifery Council Standards, and is an expected part of any shift.
“Education and supervision … usually that’s translated into job descriptions,
there’s some reference to it in most job descriptions.”
Figure 7.4: Role definition for supervisors of midwifery students and trainees in NSW (n=51)
100
Formal
90
Not formal
78.4
80
Unsure
% of respondents
70
60
50
40
30
20
13.7
7.8
10
0
Figure 7.5: Proportion of role funded for provision of supervision of midwifery students and
trainees in NSW (n=46)
100
Not funded
90
Partially funded
% of respondents
80
Fully funded
70
Unsure
60
50
43.5
40
26.1
30
20
17.4
13
10
0
7.2.6 Approach to supervision of students and trainees in midwifery
The most common approach to supervision of midwifery students and trainees
nominated by current supervisors was direct supervision, provided by a team of
supervisors.
trainees:
• the most common approaches to supervision nominated was a team approach (Table 7.3)
• interdisciplinary supervision was identified by just under half of all respondents (Figure 7.6)
97
• interdisciplinary supervision identified was a mix of informal ‘on-the-job’ supervision and
formal workplace supervision (Table 7.5).
Table 7.3: Approach to supervision of midwifery students and trainees in NSW (n=51)*
Respondents
n
%
One-to-one
10
19.6
One to > one
2
3.9
36
70.6
5
9.8
Team approach
Other approach
†
* Respondents could nominate more than one approach
†’Other’ responses referred to roles in overseeing student supervisors and in clinical supervision
Table 7.4: Type of supervision provided for midwifery students and trainees in NSW (n=48)*
Respondents
n
%
40
83.3
16
33.3
25
52.1
19
39.6
Other role
1
2.1
Figure 7.6: Interdisciplinary supervision of students, interns and trainees by midwifery
Yes
No
Unsure
51.1%
48.9%
98
Table 7.5: Type of interdisciplinary supervision provided for students and trainees by midwifery
Type of supervision
Respondents
n
%
8
36.4
13
59.1
0
0.0
Other
1
4.5
7.2.7 Years of experience of supervisors of midwifery students and trainees
Supervisors of midwifery students and trainees identified in NSW had a broad range of
years of experience both as a clinician and as a supervisor.
trainees in NSW:
• the average number of years of experience as an midwifery professional was 21.3 ± 9.4
(Figure 7.7)
• the average number of years of experience in providing supervision to midwifery students
and trainees was 12.2 ± 8.8.
Figure 7.7: Average years of experience as a clinician (n=45) and supervisor of midwifery students
and trainees (n=48)
35
supervisor
30
Number of years
25
21.3
20
15
12.2
10
5
0
Snapshot: experience of supervisors of students, trainees and interns in midwifery
NSW legislation dictates that a student undertaking a placement in an area of birth must be
supervised by a registered midwife. This could mean that the person providing supervision is
only three months more experienced than the student. In practice, this is not the case. Care is
taken with rostering systems to ensure that students are assigned to more experienced
midwives.
99
7.2.8 Training in supervision of midwifery students and trainees
Supervisors of midwifery students and trainees often undertake a preceptor training
program, offered locally by site. Midwifery professionals may also undertake other formal
or informal training.
Interview responses suggest that supervisor training within midwifery falls under the umbrella of
preceptor training offered in nursing. The content and mode of delivery of preceptor training can
vary by site.
trainees:
and Assessment
• 25 midwifery professionals indicated they had undertaken some form of informal training in
• the most common form of informal training undertaken was an external course
• some respondents indicated they were in the process of completing training, and others
had undertaken training overseas or discipline-specific training in preceptorship.
Table 7.6: Formal training in supervision undertaken by supervisors of midwifery students and
trainees in NSW (n=19)*
Respondents
n
%
11
57.9
4
21.1
Graduate diploma
3
15.8
Master’s
9
47.4
Doctorate
0
0.0
*People could choose more than one qualification
Table 7.7: Informal training in supervision undertaken by supervisors of midwifery students and
Respondents
n
%
11
44.0
LHD-run course
3
12.0
11
44.0
External course
12
48.0
5
20.0
100
Of the survey respondents who indicated they had not provided supervision for midwifery
students and trainees in the past 12 months:
• the most common form of supervision training undertaken was a Graduate diploma
• 7 indicated they had undertaken some form of informal training in supervision (Table 7.9)
• the most common form of informal training undertaken was an LHD-run course.
Table 7.8: Formal training in supervision undertaken by non-supervising midwifery professionals
†
(n=6)*
2
Graduate diploma
4
Master’s
2
*Respondents could choose more than one qualification; % not included because of low numbers
on supervision
Table 7.9: Informal training in supervision undertaken by non-supervising midwifery professionals
(n=7)*
5
LHD-run course
3
1
1
* Respondents could choose more than one qualification; % not included because of low numbers
7.3
CAPACITY FOR SUPERVISION OF STUDENTS AND TRAINEES IN MIDWIFERY
7.3.1 Duration of midwifery student and trainee placements
Placements for midwifery students and trainees are varied, ranging from short-term
placements of less than one week, to full-time, 12 month placements.
Survey responses from individuals who identified as providing supervision for midwifery students
and trainees illustrated that the duration of placements for midwifery students and trainees is
varied (Table 7.10).
101
Table 7.10: Typical duration of midwifery student, trainee and intern placements in NSW (n=47)
n
%
13
27.7
21
44.7
14
29.8
18
38.3
15
31.9
* Respondents could choose more than one placement duration
7.3.2 Time spent supervising midwifery students and trainees
The majority of supervisors of midwifery students and trainees typically work in full-time
roles. The time spent providing supervision varies from less than 5 hours per week to
more than 30 hours per week.
Of the survey respondents who identified as providing supervision for students and trainees in
midwifery:
7.11)
• almost one-quarter (22.9%) indicated they provide between 5 and 10 hours of supervision
per week (Table 7.12)
• just over 10% provide supervision for more than 30 hours per week.
midwifery students and trainees in NSW (n=45)
Respondents
n
%
<15
3
6.7
15–20
3
6.7
20–25
2
4.4
25–30
4
8.9
30+
33
73.3
102
Table 7.12: Average number of hours per week spent supervising midwifery students and trainees
in NSW (n=48)
Average hours providing supervision to students and
trainees per week
Respondents
n
%
<1–5
8
16.7
5–10
11
22.9
10–15
8
16.7
15–20
5
10.4
20–25
8
16.7
25–30
3
6.3
30+
5
10.4
More than half of supervisors of midwifery students and trainees indicated they are at
Around one-third of current supervisors of midwifery students and trainees indicated
some capacity for additional supervision and most of the midwifery professionals not
Current supervisors
trainees:
• over half (53.2%) indicated they were at capacity, and could not take on further supervision
(Table 7.13)
• over one-third (36.2%) indicated they had some capacity for additional supervision.
Table 7.13: Supervision capacity for current supervisors of midwifery students and trainees in
NSW (n=47)
Respondents
n
%
At capacity
25
53.2
Some capacity
17
36.2
Underutilised
3
6.4
Other
2
4.3
Of survey respondents who indicated they had not provided supervision for midwifery students
and trainees in the past 12 months:
• most (87.5%) indicated they had capacity and interest in undertaking supervision (Table
7.14).
103
Table 7.14: Supervision capacity for midwifery professionals not currently providing supervision
of students and trainees (n=8)*
No capacity
0
7
Not interested
0
Unsure
1
*Percentages not reported due to low number of responses
For current and non-current supervisors of midwifery students and trainees, the major
Current supervisors
trainees:
• other high-rating factors included staff to patient ratios (42.6%) and incentives for
supervisors (23.4%)
• dealing with underperforming students was nominated as a factor by 19.1% of
respondents.
Table 7.15: Factors affecting capacity for supervision of midwifery students and trainees in NSW
for current supervisors (n=47)*
Respondents*
n
%
teaching
41
87.2
9
19.1
20
42.6
5
10.6
11
23.4
6
12.8
Access to training
7
14.9
5
10.6
9
19.1
Other
†
responses.
†
Other comments related to factors influencing capacity for supervision
104
The following were identified by midwifery professionals who are currently providing supervision
as factors that influence their capacity to undertake more supervision:
• lack of dedicated time
• supervision of graduate midwifes
• staffing shortages
• lack of role recognition
• lack of access to facilities for supervision e.g. consulting rooms
• training
• caseload/workload
• insufficient information about the students
• reduction in time spent on administrative duties.
Information about barriers to supervision was identified for the 18 midwifery professionals who
did not indicate a lack of interest in providing supervision for students and trainees:
(nominated by 25% of respondents) (Table 7.16)
• ‘other’ factors were identified by 62.5% of respondents; these included: dedicated time and
less administrative work.
Table 7.16: Factors affecting capacity for supervision of midwifery students and trainees in NSW
for those not providing supervision (n=8)*
Number of
respondents
teaching
2
1
Other
5
*Percentages and totals are based on respondents; zero response options not listed
7.4
CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR MIDWIFERY STUDENTS
AND TRAINEES
The most important core skill nominated by supervisors of students and trainees in
midwifery was ‘clinical skills and knowledge’. The least important skill was ‘remediation
of underperforming students’.
105
trainees:
• ‘clinical skills and knowledge’ was identified as the most important core skill by 57% (n=21)
of respondents (Figure 7.8), a further 19% (n=7) of respondents ranked it as the second
• ‘interpersonal skills’ was identified as the most important core skill by 37% (n=16)
respondents, a further 21% (n=9) of respondents ranked it as the second most important
skill
Figure 7.8 Core skill ranked as most important (rank=1) for supervisors of midwifery students and
trainees
100
% of respondents
90
80
70
57
60
50
37
40
30
20
11
10
3
3
3
0
Figure 7.9: Core skill ranked as least important (rank=7) by supervisors of midwifery students and
trainees
100
90
% of respondents
80
70
60
50
41
40
30
16
20
10
5
6
6
6
7
0
106
A total of 8 survey respondents who indicated that they had not provided supervision for
midwifery students and trainees in the past 12 months attempted to rank the core skills of a
• a total of 4 respondents identified ‘interpersonal skills’ as the most important core skill (i.e.
a rank of 1 or 2) (Table 7.18)
• a total of 2 respondents identified ‘clinical skills and knowledge’, ‘adult teaching and
learning skills’ and ‘ability to give and receive feedback’ as the most important core skill
by (i.e. a rank of 1 or 2)
• a total of 4 respondents identified ‘remediation of poorly performing students’ as the least
important core skill (i.e. a rank of 6–7).
Percentages have not been provided because of low respondent numbers.
supervision of midwifery students and trainees
Rank 1–2
Rank 3–5
Rank 6–7
No. of
respondents
No. of
respondents
No. of
respondents
2
2
2
(n=6)
2
1
3
(n=6)
2
4
0
1
2
2
Self-evaluation and reflection (n=5)
1
3
1
students (n=7)
1
2
4
4
4
0
* Not all respondents ranked all skills
107
8.
PROFILE OF SUPERVISORS OF STUDENTS AND TRAINEES IN
NURSING
This chapter refers to ‘students and trainees’ as opposed to ‘students, trainees and interns’.
Key findings
• A variety of roles are involved in supervision of nursing students and trainees on
placements. Direct and indirect supervision is provided by registered nurses, preceptors
and facilitators.
nursing students and trainees in NSW.
• Supervisors of nursing students and trainees were identified in all Local Health Districts
(LHDs), Specialist Health Networks and training institutions.
• The most common work setting for supervisors of nursing students and trainees identified
was hospital/ward-based care (45.7%).
• The majority of supervisors of nursing students and trainees identified were female
(84.7%) and over 40 years of age (72%).
• The majority of supervisors of nursing students and trainees identified indicated that
supervision is an expected part of their role (77.7%), but is not specifically funded
(52.8%).
• The most common approach to supervision of nursing students and trainees nominated by
current supervisors was direct supervision (70.5%), provided by a team of supervisors
(73%).
• Supervisors of nursing students and trainees identified had a broad range of years of
experience both as a clinician (22.0 ± 10.3 years) and as a supervisor (12.8 ± 8.6 years).
• Supervisors of nursing students and trainees often undertake preceptor training, offered
locally. Nursing professionals may also undertake other formal or informal training.
• A total of 254 supervisors of nursing students and trainees indicated had undertaken
formal supervision training. In addition, 73 supervisors indicated they had undertaken
some form of informal supervisor training.
• Placements for nursing students and trainees can range from short-term to full-time
duration. The most reported duration of student and trainee placement was medium-term
placements between 1 week and 1 month (70.8%).
• The majority of supervisors of nursing students and trainees typically work in full-time roles
(82.6%). The time spent providing supervision varies from less than 5 hours per week
(30.8%) to more than 30 hours per week (14.8%).
• More than half (55.1%) of supervisors of nursing students and trainees indicated they are
at capacity, and could not take on further supervision.
• Around one-third (30.7%) of current supervisors of nursing students and trainees indicated
some capacity for additional supervision and half (50.9%) of nursing professionals not
• For current and non-current supervisors of nursing students and trainees, the major factor
influencing capacity to undertake supervision is the balance between service delivery
and teaching.
• The most important core skill nominated by supervisors of students and trainees in nursing
was ‘clinical skills and knowledge’ (55%). The least important skill was ‘remediation of
108
underperforming students’ (31%).
8.1
OVERVIEW OF STUDENT AND TRAINEE SUPERVISION IN NURSING
A variety of roles are involved in the supervision of nursing students and trainees on
placements. Direct and indirect supervision is provided by registered nurses, preceptors
and facilitators.
Interviews conducted with people involved in the supervision of nursing students and trainees
indicate there are a variety of roles involved in the supervision of nursing students and trainees
on placements.
Student and trainee placements are coordinated by a facilitator. The facilitator acts as a link
between the training institution and the placement site. A facilitator may be a registered nurse
employed by the training institution who travels between placement sites, or they may be a
registered nurse, working at the placement site, but funded to act as a facilitator by the training
institutions when required.
“Facilitators are sort of the link between the education provider and the clinical
area.”
Generally, facilitators are required to visit a placement site prior to the commencement of a
student placement to speak with the nursing unit manager and clinical nurse educator of a site.
During student placement, the facilitator will meet with and coordinate the student, but will
typically not supervise that student on a day-to-day basis. Facilitators may run educational
tutorials for students during their placement.
“… students will go to their various placements and it is the role of the facilitator
to meet them and then take them to their particular ward, and then the students
are then quite often allocated a registered nurse to work with.”
“… in some cases what will also happen, well the facilitator may also work with
individual students on a particular shift. But they are mainly there to, if you like,
coordinate the student’s learning experience.”
Students and trainees will be supervised on a daily basis by a registered nurse. The registered
nurse providing this supervision is known as a preceptor. Registered nurses are offered
preceptor training by their LHDs.
“…when they (students) get on the unit or the ward, usually they’ll have a
preceptor and that preceptor would be a one-to-one.”
Supervision of nursing students and trainees will be provided at the point of patient care. There
may also be a reflective component of supervision, where students and their facilitator reflect on
practice.
8.2
PROFILE OF SUPERVISORS OF NURSING STUDENTS AND TRAINEES
8.2.1 Number of supervisors of nursing students and trainees
nursing students and trainees in NSW.
The survey identified:
• 470 individuals who indicated they have provided supervision for nursing students and
trainees in the past 12 months (Figure 8.1).
109
• 106 nursing professionals who indicated they have not provided supervision for students
and trainees in the past 12 months, but have provided supervision previously (Figure
8.1). These people represent a potential additional source of supervisors in NSW.
Figure 8.1: Nursing professionals who are currently supervising, have previously supervised or
have never supervised students and trainees (n=614)
500
470
450
400
350
Never
300
Unsure
250
200
150
106
100
50
34
4
0
8.2.2 Location of current supervisors of nursing students and trainees
Supervisors of nursing students and trainees were identified in all LHDs, Specialist
Health Networks and training institutions.
Information about location was provided by 385 of the survey respondents who identified as
providing supervision for nursing students and trainees. Of these:
• the highest number were from South Eastern Sydney, Northern Sydney and Mid North
Coast (Table 8.1)
• the lowest numbers were from Nepean Blue Mountains, Far West and Northern NSW
• a total of 26 were identified in Specialist Health Networks (Table 8.2)
• a small number were working in the university and TAFE/(Vocational Education and
Training (VET) college sectors (Table 8.3).
Table 8.1: Location of supervisors of nursing students and trainees in NSW, by LHD
metropolitan
Number of
supervisors
rural and regional
Number of
supervisors
Central Coast
27
Far West
8
22
Hunter New England
16
5
Mid North Coast
38
Northern Sydney
45
Murrumbidgee
24
61
Northern NSW
11
17
Southern NSW
28
Sydney
16
Western NSW
16
Western Sydney
23
Total metropolitan
216
141
110
111
Table 8.2: Location of supervisors of nursing students and trainees in NSW, by Specialist Health
Network (n=26)
Number of
supervisors
15
9
2
Table 8.3: Location of supervisors of nursing students and trainees in NSW, by non-LHD
institution (n=14)
Institution type
Number of
supervisors
University
7
7
8.2.3 Work setting in which supervision is currently provided for nursing
The most common work setting for supervisors of nursing students and trainees
identified was hospital/ward-based care.
Of the survey respondents who identified as providing supervision for nursing students and
trainees:
• almost half (45.7%) indicated that supervision is provided in a hospital or ward-based
setting (Table 8.4)
• a total of 32 (6.8%) nursing supervisors identified as providing supervision in a rural or
remote setting
• ‘other’ settings, nominated by 86 (18.4%) respondents included: specialty contexts, such
as surgery, intensive care, dialysis and renal care, drug and alcohol services, youth and
women’s health; a range of outpatient settings; Aboriginal Medical Services; health
promotion; online context; education; and Justice Health.
Table 8.4: Setting in which supervision of nursing students and trainees is provided (n=468)*
Supervisors
n
%
64
13.7
Aged care
70
15.0
Mental health
91
19.4
Primary health care
41
8.8
81
17.3
Rural remote care
32
6.8
Emergency
74
15.8
Hospital/ward based care
214
45.7
Other
86
18.4
112
nursing supervisors. Of these, 10.9% indicated they also work within a private setting.
8.2.4 Demographics of supervisors of nursing students, interns and trainees
The majority of supervisors of nursing students and trainees identified in NSW were
female and over 40 years of age.
trainees:
• the vast majority (84.7%) were female (Figure 8.2)
• the majority were aged in their 40’s (36.4%) and 50’s (35.6%) (Figure 8.3).
Figure 8.2: Gender of people providing supervision for nursing students and trainees in NSW
(n=385)
Male
15.3%
Female
84.7%
% of respondents
Figure 8.3: Age of people providing supervision to nursing students and trainees in NSW (n=385)
100
20–29 years
90
30–39 years
80
40–49 years
50–59 years
70
60+ years
60
50
36.4
40
35.6
30
16.6
20
10
3.9
7.5
0
113
8.2.5 Recognition of the role of student and trainee supervision in nursing
The majority of supervisors of nursing students and trainees identified in NSW indicated
that supervision is a formal or expected part of their role, but is not specifically funded.
trainees:
• over three-quarters (77.7%) indicated that supervision of students and trainees is a
• just over half (52.8%) of supervisors indicated they receive no funding for the provision of
supervision of students and trainees (Figure 8.5).
Interview responses suggested that the provision of supervision to nursing students and trainees
is an expected part an experienced nurse’s role. The expectation of supervision is reflected in
the different nursing roles. For example, the role of supervisor forms part of the performance
development review of a clinical nurse specialist (CNS).
“It’s actually documented in my performance development reviews and also
because I’m a clinical nurse specialist … it comes under one of the areas of
expertise that you use to justify your ongoing CNS status.”
The roles of preceptor and facilitator are unique to supervision in nursing. These roles are
generally formalised through training. Supervision of students is both expected and recognised
in these roles.
Provision of supervision by nurses is undertaken in goodwill and is not specifically funded.
“… they don’t get additional funds for it, they don’t get additional time for it. It's
just to be incorporated in their normal activities. Now, most take that on with
gusto and enjoy it, but some are not, not all of us are born as good teachers and
supervisors and some people are not the most pleasant at it.”
Figure 8.4: Role definition for supervisors of nursing students and trainees in NSW (n=466)
100
Formal
90
% of respondents
80
Not formal
77.7
Unsure
70
60
50
40
30
20
10
17.6
4.7
0
114
Figure 8.5: Proportion of role funded for provision of supervision of nursing students and trainees
in NSW (n=396)
100
Not funded
% of respondents
90
Partially funded
80
Fully funded
70
Unsure
60
52.8
50
40
30
20.2
19.7
20
7.3
10
0
8.2.6 Approach to supervision of students and trainees in nursing
The most common approach to supervision of nursing students and trainees nominated
by current supervisors was direct supervision, provided by a team of supervisors.
trainees:
• the most common approach to supervision nominated was a team approach (Table 8.5)
• interdisciplinary supervision was identified by one-third of respondents (Figure 8.6)
• interdisciplinary supervision identified was a mix of informal ‘on-the-job’ supervision and
formal workplace supervision (Table 8.7).
Table 8.5: Approach to supervision of nursing students and trainees in NSW (n=470)*
Respondents
n
%
One-to-one
65
13.8
One to > one
69
14.7
343
73.0
21
4.5
Team approach
Other approach
†
†
Responses to ‘other approaches to supervision’ included descriptions of roles as university facilitators, managers of
university facilitators, managers of student supervisors, placement coordinators and student assessors.
115
Table 8.6: Type of supervision provided for nursing students and trainees in NSW (n=454)*
Respondents
n
%
320
70.5
162
35.7
242
53.3
153
33.7
Other role
15
3.3
Figure 8.6: Interdisciplinary supervision of students and trainees by nursing professionals in NSW
(n=390)
Yes
2.3%
No
35.4%
Unsure
62.3%
Table 8.7: Type of interdisciplinary supervision provided for students and trainees by nursing
Type of supervision
Respondents
n
%
31
24.0
94
72.9
3
2.3
Other
1
0.8
116
8.2.7 Years of experience of supervisors of nursing students and trainees
Supervisors of nursing students and trainees identified in NSW had a broad range of
years of experience both as a clinician and as a supervisor.
trainees in NSW:
• the average number of years of experience as an nursing professional was 22.0 ± 10.3
(Figure 8.7)
• the average number of years of experience in providing supervision to nursing students
and trainees was 12.8 ± 8.6.
Figure 8.7: Average years of experience as a clinician (n=385) and supervisor of nursing students
and trainees (n=430)
35
30
supervisor
Number of years
25
22.0
20
15
12.8
10
5
0
8.2.8 Training in supervision of nursing students and trainees
Supervisors of nursing students and trainees often undertake preceptor training, offered
locally. Nursing professionals may also undertake other formal or informal training.
trainees:
and Assessment
• 73 nursing professionals indicated they had undertaken some form of informal training in
• the most common form of informal training undertaken was an LHD-run seminar/workshop.
Other reported sources of training in supervision included: preceptorship and other supervision
training for nurses; postgraduate mentorship programs; and courses offered overseas. Some
respondents reported being in the process of completing a relevant qualification.
117
Table 8.8: Formal training in supervision undertaken by supervisors of nursing students and
†
Respondents
n
%
154
60.6
100
39.4
Graduate diploma
54
21.3
Master’s
77
30.3
Doctorate
4
1.6
on supervision
Table 8.9: Informal training in supervision undertaken by supervisors of nursing students and
Respondents
n
%
110
46.0
LHD-run course
53
22.2
94
39.3
External course
54
22.6
84
35.1
Of the survey respondents who indicated they had not provided supervision for nursing students
• the most common form of supervision training undertaken was a Certificate IV in
Workplace Training and Assessment
8.11)
• the most common form of informal training undertaken was an LHD-run seminar/workshop
• other reported sources of training for non-supervisors included: nursing degrees with
supervision content; education degrees; preceptor training; and training in psychiatric
nursing.
118
Table 8.10: Formal training in supervision undertaken by non-supervising nursing professionals
(n=73)*
Respondents
n
%
36
49.3
22
30.1
Graduate diploma
17
23.3
Master’s
27
37.0
Doctorate
2
2.7
Table 8.11: Informal training in supervision undertaken by non-supervising nursing professionals
(n=57)*
Respondents
n
%
36
63.1
LHD-run course
22
38.6
17
29.8
27
47.3
8.3
CAPACITY FOR SUPERVISION OF STUDENTS AND TRAINEES IN NURSING
8.3.1 Duration of nursing student and trainee placements
Placements for nursing students and trainees can range from short-term to full-time
duration. The most reported duration of student and trainee placement was medium-term
placements between 1 week and 1 month.
Survey responses from individuals who identified as providing supervision for nursing students
and trainees illustrated that the duration of placements for nursing students and trainees is
varied. Medium-term placements of between 1 week and 1 month were most highly reported
(Table 8.12).
Table 8.12: Typical duration of nursing student and trainee placements in NSW (n=394)
n
%
152
38.6
279
70.8
114
28.9
47
11.9
83
21.1
*Respondents could choose more than one placement duration
119
8.3.2 Time spent supervising nursing students and trainees
The majority of supervisors of nursing students and trainees typically work in full-time
roles. The time spent providing supervision varies from less than 5 hours per week to
more than 30 hours per week.
Of the survey respondents who identified as providing supervision for students and trainees in
nursing:
8.13)
• almost one-third (30.8%) indicated they provide less than 5 hours of supervision per week
(Table 8.14)
• almost 15% provide supervision for more than 30 hours per week.
nursing students and trainees in NSW (n=385)
Respondents
n
%
<15
5
1.3
15–20
13
3.4
20–25
26
6.8
25–30
23
6.0
30+
318
82.6
Table 8.14: Average number of hours per week spent supervising nursing students and trainees in
NSW (n=445)
Average hours providing supervision to students and
trainees per week
Respondents
n
%
<1–5
137
30.8
5–10
103
23.1
10–15
51
11.5
15–20
44
9.9
20–25
26
5.8
25–30
18
4.0
30+
66
14.8
More than half of supervisors of nursing students and trainees indicated they are at
Around one-third of current supervisors of nursing students and trainees indicated some
capacity for additional supervision and half of nursing professionals not providing
120
Current supervisors
trainees:
• over half (55.1%) indicated they were at capacity, and could not take on further supervision
(Table 8.15)
• almost one-third (30.7%) indicated they had some capacity for additional supervision.
Table 8.15: Supervision capacity for current supervisors of nursing students and trainees in NSW
(n=410)
Respondents
n
%
At capacity
226
55.1
Some capacity
126
30.7
Underutilised
31
7.6
Other*
27
6.6
* ‘Other’ reported sources of training for non-supervisors included: nursing degrees with supervision content;
education degrees; preceptor training; and training in psychiatric nursing
Of survey respondents who indicated they had not provided supervision for nursing students and
trainees in the past 12 months:
• half (50.9%) indicated they had capacity and interest in undertaking supervision (Table
8.16).
Table 8.16: Supervision capacity for nursing professionals not currently providing supervision of
students and trainees (n=116)
Respondents
n
%
No capacity
40
34.5
59
50.9
Not interested
8
6.9
Unsure
9
7.8
For current and non-current supervisors of nursing students and trainees, the major
121
Current supervisors
trainees:
Table 8.17: Factors affecting capacity for supervision of nursing students and trainees in NSW for
current supervisors (n=409)*
Respondents*
n
%
teaching
319
78.0
116
28.4
160
39.1
71
17.4
70
17.1
68
16.6
Access to training
50
12.2
45
11.0
59
14.4
Other
†
responses.
†Other responses typically related to factors influencing capacity for supervision
The following were identified by nurses who are currently providing supervision as factors that
influence their capacity to undertake more supervision:
• insufficient staffing levels, particularly senior staff and clinical education staff, and staff to
backfill positions
• lack of dedicated time for student supervision
• overlap with supervision of postgraduate students and staff
• lack of advance notice of student placements
• lack of role recognition and financial incentives
• insufficient communication with/from training institutions regarding placement
requirements, objectives and student skills
• insufficient face-to-face time with university facilitator in service context
• lack of training
• levels of student interest and engagement
• levels of support from management
• administrative requirements of supervisors.
122
Information about barriers to supervision was identified for the 81 nursing professionals who did
not indicate a lack of interest in providing supervision for students and trainees:
(nominated by 32.1% of respondents) (Table 8.18).
Table 8.18: Factors affecting capacity for supervision of nursing students and trainees in NSW for
those not providing supervision (n=81)*
Respondents
n
%
teaching
26
32.1
10
12.3
9
11.1
9
11.1
6
7.4
11
13.6
6
7.4
Access to training
11
13.6
13
16.0
7
8.6
32
39.5
†
Other
responses.
† Themes arising in the ‘other’ responses are reported together with factors that would help improve capacity to
undertake supervision
The following were identified by non-supervisor nurses as factors that would help improve their
capacity to undertake supervision:
• dedicated time for supervision
• lower caseloads/workloads
• cultural change
• supportive management
• improved contact and organisation with universities
• interested students
•
facilities for supervision access to training.
123
8.4
CORE SKILLS OF PEOPLE PROVIDING SUPERVISION FOR NURSING STUDENTS
AND TRAINEES
The most important core skill nominated by supervisors of students and trainees in
nursing was ‘clinical skills and knowledge’. The least important skill was ‘remediation of
underperforming students’.
Current supervisors
trainees:
• ‘clinical skills and knowledge’ was identified as the most important core skill by 55% of
respondents (Figure 8.19), a further 19% of respondents ranked it as the second most
important skill
• ‘interpersonal skills’ was identified as the most important core skill by 26% of respondents,
a further 22% of respondents ranked it as the second most important skill
core skills by 31% of respondents (Figure 8.20).
Figure 8.19 Core skill ranked as most important (rank=1) for supervisors of nursing students and
trainees
% of respondents
100
90
80
70
60
55
50
40
26
30
20
10
15
6
3
4
3
0
124
Figure 8.20: Core skill ranked as least important (rank=7) by supervisors of nursing students and
trainees
100
90
80
% of respondents
70
60
50
40
31
26
30
20
10
4
10
8
8
3
0
Of the survey respondents who indicated they had not provided supervision for nursing students
• ‘clinical skills and knowledge’ was identified as the most important core skill (i.e. a rank of
1 or 2) by 66.7% of respondents (Table 8.19)
• ‘interpersonal skills’ was identified as the most important core skill by (i.e. a rank of 1 or 2)
48.5% of respondents
• ‘remediation of underperforming students’ was identified as the least important core skill
(i.e. a rank of 6 or 7) by 57.1% of respondents.
supervision of nursing students and trainees
Rank 1–2
Rank 3–5
Rank 6–7
% of respondents
% of respondents
% of respondents
66.7
19.4
14.0
(n=91)
42.9
33.0
24.2
(n=90)
24.4
63.3
12.2
3.6
64.3
32.1
(n=95)
25.3
52.6
22.1
students (n=98)
8.2
34.7
57.1
48.5
30.1
21.4
* Not all respondents ranked all skills
125
126
9.
CONSIDERATIONS FOR A TRAINING STRATEGY FOR
SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS
Key perspectives
• Survey respondents from across the disciplines nominated ‘clinical skills and knowledge’
as the most important core skill for supervisors of students, trainees and interns.
Interview respondents from across the disciplines highlighted the importance of skills in
• Interview participants typically highlighted gaps in supervision and adult education skills
(rather than clinical skills) for supervisors of students, trainees and interns.
• Current supervisors identified both formal and informal training courses in supervision.
• Background research together with survey and interview responses identified the following
formal training programs available to supervisors of students, trainees and interns.
• Interview responses indicated that informal training courses are most commonly
implemented by a training institution prior to sending students on clinical placement, or
provided by the LHD at a facility level.
• Survey feedback suggests there is interest among current supervisors in undertaking
training in supervision, with more interest in informal training such as LHD-based
seminars than formal training courses.
• Survey and interview feedback suggests that training for supervisors of students, trainees
and interns should incorporate face-to-face components, such as seminars/workshops.
• A network of support for supervisors may be useful, to enable supervisors to learn from
• Lack of time was identified as the primary barrier to attending training in supervision by
current supervisors of students, trainees and interns. Cost of training was a barrier for
more than half of allied health, nursing and midwifery supervisors.
• Affiliation with professional colleges and introduction of training as a component of
professional awards may be incentives for participation in training for supervisors.
• Interviews suggest there appears to be little accreditation or governance that formalises
the skills required for supervisors.
• Interview feedback suggests a training strategy to increase capacity for supervision of
students, trainees and interns should be equitable and flexible, and focus on a
supervisor’s skills in supervision as well as their clinical knowledge.
• Interview and survey feedback highlighted that a training strategy to increase capacity for
supervision of students, trainees and interns should recognise and reflect the contextual
differences that influence provision of supervision, including differences based on
discipline, location and service setting.
• Other issues that may influence approaches to increase capacity include regional
resources, differences in remuneration for supervisors between disciplines, evaluation of
supervisor roles and interdisciplinary supervision.
127
9.1
CORE SKILLS OF SUPERVISORS
The CSSP Environmental Scan and Research, conducted by John Ramsey and Associates,
defined a list of core skills essential in a good supervisor. These core skills were reviewed by the
Project Advisory Committee and it was agreed that these skills, with the addition of ‘selfevaluation and reflection’ were appropriate skills required in supervisors of students, trainees
and interns, regardless of discipline. The core skills identified for supervisors included:
• clinical skills and knowledge
• adult teaching and learning skills
• ability to give and receive feedback
• appraisal and assessment
• remediation of poorly performing students
• interpersonal skills.
9.1.1 Overall rating of core skills for supervisors
Survey respondents from across the disciplines nominated ‘clinical skills and knowledge’
as the most important core skill for supervisors of students, trainees and interns.
Interview respondents from across the disciplines highlighted the importance of skills in
Sections 4 to 8 outline the core skills for supervisors of students, trainees and interns nominated
by different discipline groups. Table 9.1 list the top three core skills as ranked in the number 1
position for each discipline. While some variation between disciplines was apparent, all
disciplines ranked ‘clinical skills and knowledge’ as the most important core skill for supervisors
of students, trainees and interns. ‘Interpersonal skills’ also ranked highly among the individual
disciplines as an important skill for supervisors.
Feedback in the comments field within the survey indicated that many respondents found this
question difficult to complete. Respondents indicated that it was hard to rank skills that they
believed were all equally important.
Interview participants were also asked about the core skills needed by supervisors of students,
trainees and interns. While the need to consider specific supervision requirements of different
contexts was raised by some, several core skills were common across disciplines (Table 9.2). A
notable difference between the interview responses and electronic survey responses was the
emphasis placed by interviewees on the need for an understanding of adult learning principles,
communication skills and critical review and reflection.
“So the (general) principles (of supervision) don’t (change) with profession, you
know those general principles of getting people to reflect on action, reflect in
action to be supportive, to be developing their critical thinking capacity, those
things are common to all of us.”
128
Table 9.1: Top three most important core skills by discipline
Ranking
Allied health (n=710)*
Dentistry (n=28)*
Medicine (n=299)*
Midwifery (n=43)*
Nursing (n=350)*
1
(received
highest
number of
number 1
rankings)
Clinical skills and
knowledge
(n=328)
nd
A further 142 ranked as 2
Clinical skills and
knowledge
(n=17)
nd
Clinical skills and
knowledge
(n=105)
nd
Clinical skills and
knowledge
(n=21)
nd
Clinical skills and
knowledge
(n=184)
nd
2
(received
second
highest
number of
number 1
rankings)
(n=132)
nd
Adult teaching and
learning skills
(n=6)
nd
(n=71)
nd
(n=16)
nd
(n=91)
nd
3
(received
third
highest
number of
number 1
rankings)
Ability to give and
receive feedback
(n=95)
nd
(n=4)
nd
Adult teaching and
learning skills
(n=53)
nd
Remediation of poorly
performing students
(n=4)
nd
Adult teaching and
learning skills
(n=48)
nd
*Number of respondents who attempted to rank skills in this question. Not all respondents ranked all skills.
HETI NSW Clinical Supervision Support Project report FINAL draft
Page 129 of 235
Table 9.2: Core skills required by supervisors of students, trainees and interns identified by
interview respondents
Core skill
Clinical knowledge
and experience
Adult teaching and
learning principles
Communication
skills
Critical review and
reflection
Mutual
understanding of
expectations and
purpose of the
clinical placement
Enthusiasm
Detail
•
Relevant, discipline-specific clinical skills and knowledge are important.
•
A supervisor’s clinical experience is often taken into account when assigned to
students, interns or trainees, but some interviewees suggested this is not
always the case.
•
Adult learning skills and an understanding of how different individuals learn are
core skills of a supervisor.
“To be effective as a teacher … you have to understand how people learn. For
that to happen you have to have an understanding of what people call adult
learning theories, but really it is about being respectful of the learner’s needs.”
“It’s not really what they need to learn, it’s how they need to learn it and the
depth that they need to learn it that the (supervisor) needs to understand.”
•
Linked with adult learning skills is a recognition that the purpose of a clinical
placement is as an experiential learning experience.
“Because learning from experience, and that’s what clinical placement is,
that’s what clinical supervision’s about is actually helping the learning to make
the connection between their knowledge and their practice and their craft.”
•
Supervisors need to be supportive of students in practice.
“The good (supervisors) are the ones that can say, ‘look there are about five
different ways of doing this, I was taught like this, I’ve learnt to develop it like
that over time, trends are happening…we’re having to do things these ways’.
They’re the ones that can say, ‘I tend to do it this way…but bottom line is it’s
safe, it minimises risk to the patient’.”
•
It is important to be able to ‘think out loud’ in order to communicate internal
decision-making processes to students.
•
Supervisors need communication skills to be able to have difficult
conversations with students and deal with conflict or personality clashes.
•
Being able to provide negative feedback and have difficult conversations is a
key skill required.
“Unless you’re very senior you rarely get to deal with a difficult trainee or the
struggling doctor, or how to actually supervise a student properly: you just
don’t get taught that.”
•
It is important for facilitators to be able to think critically, to review and reflect
on their own performance and to assist students to do the same.
“The key to good (supervision) is that (the supervisor) becomes your eyes and
ears and they virtually train you how to reflect in action.”
•
Supervisors require good observation skills to be able to assist learners to
identify and critically reflect on key components of an experience and learn
from them.
•
Supervisors benefit from an understanding of the current skills, experience and
expectations of each student, and the current generation of students as a
whole.
“I think that (clinicians) probably would be more interested and possibly
enthusiastic (about student supervision) if they understood more about where
the students are coming from, what they are up to and the students’ learning
experience”.
•
Supervisors also require an understanding of the formal requirements for
student supervision including accreditation and core competencies.
•
“The single most important thing that a (supervisor) can offer students is
enthusiasm.”
HETI NSW Clinical Supervision Support Project – Report DRAFT 1_BS reviewed
Page 130 of 235
9.1.2 Skills gaps for supervisors of students, trainees and interns
Interview participants typically highlighted gaps in supervision and adult education skills
(rather than clinical skills) for supervisors of students, trainees and interns.
Interview participants were asked to identify perceived gaps in skills within the current
supervision workforce. The gaps in skills identified by participants were closely linked with the
identified core skills for supervisors and are summarised in Table 9.3. While some issues were
noted in clinical skills of supervisors, more common feedback related to skills in the process of
providing supervision such as understanding of adult learning principles and understanding the
role of the supervisor.
When discussing skills gaps, some respondents noted that lack of staff meant they were not
able to be selective in choosing supervisors to provide supervision to students, trainees and
interns in the workplace.
“We’re always struggling to find people so we’re not selective anyway.”
Survey participants were not asked to identify skill gaps. However, the emphasis in the survey
on clinical skills rather than specific supervision skills (such as remediation of underperforming
students) suggests that supervisors may not recognise the need for training in these areas.
While not explicitly asked in the survey, the identification by current supervisors of lack of time
as a factor influencing capacity to provide supervision suggests that up-skilling supervisors in
how to provide supervision in a way that minimises impact on daily practice may be beneficial.
Table 9.3: Overview of skill gaps for supervisors of students, interns and trainees identified
through interviews
Skill gap
Detail
Clinical knowledge
and experience
• Some gaps in clinical knowledge and experience were identified.
“You would expect that they should have some clinical experience in the area
in which they’re facilitating but we find in mental health we often get nurses
coming to facilitate … who have never worked in mental health.”
Adult teaching and
learning principles
• Optimal adult teaching and learning skills were identified as a skill gap.
“It’s not really what they need to learn, it’s how they need to learn it and the
depth that they need to learn it that the (supervisor) needs to understand.”
“The tailoring of that (supervision) approach to different student types based
on the kinds of courses that they’re doing.”
“(We have) quite large problems where the student supervisors, our
clinicians, do not amend or change their supervisory style, nor their
expectations of the students (according to their level).”
Critical review and
reflection
• Providing critical feedback is a challenge for some supervisors.
“It is about having difficult conversations where they need to have difficult
conversations.”
“Supervisors find it hard to say look, this student has not met competency in
a particular clinical area and therefore would fail this placement.”
131
Skill gap
Detail
Understanding roles
and responsibilities of
supervisor and
student
• Some supervisors find it challenging to understand the skill level of their
students.
“When you have students who have quite a compressed student placement
number of days or hours in a Master’s program, I think the supervisors
flounder a little bit on how fast … to push. And where their role is.”
• Some supervisors need to develop their understanding about the
responsibilities of students in patient care.
“Because they are the supervising nurse, they have the clinical responsibility
for patient care and I think the understanding around that generally in the
workplace is a little bit lacking.”
Understanding of
generational learning
styles
9.2
• Understanding generational change in how students, trainees and interns
learn was noted as a skill gap among supervisors.
• One interview participant made the observation that many clinicians have
been providing supervision for many years, without changing their
supervision style. Understanding, and adapting to, the expectations of the
current generation of students progressing through the system is important to
ensure key teachings are delivered in an appropriate manner.
EXISTING TRAINING PROGRAMS IN CLINICAL SUPERVISION
9.2.1 Existing training programs identified through the mapping study
Current supervisors identified both formal and informal training courses in supervision.
A total of 544 current supervisors identified through the electronic survey indicated they had
completed some type of formal training course in supervision. Formal training courses that
respondents could select included Doctorate, Master’s degree, Graduate diploma or Graduate
certificate, or the Certificate IV in Workplace Training and Assessment. Comments fields within
the survey indicate that many of these courses included a component relevant to supervision,
rather than focussing solely on supervision.
In addition, a total of 979 current supervisors identified through the electronic survey indicated
they had completed some type of informal training course in supervision. Informal training
courses that respondents could select included LHD-run workshops and seminars, workshops
and seminars run externally to the LHDs or university-delivered programs.
A listing of existing clinical supervision training programs has been compiled from a variety of
sources, including:
• Clinical Supervision Support Program Environmental Scan and Research Report,67
produced by John Ramsay and Associates, which identified formal training courses in
supervision, delivered nationally
• internet searches of NSW and national university, TAFE and VET college programs
• internet searches of professional college programs
• programs identified in ‘Other’ fields of the electronic survey responses
• programs identified during telephone interviews.
A comprehensive list of these courses and the discipline at which they are directed is available
in Appendix VIII. An overview of some common formal and informal training programs identified
through this mapping study is provided in the following sections.
6
Clinical Supervision Support Program: Environmental Scan and research. John Ramsey & Associates 2011, data not yet
published.
132
9.2.2 Existing formal training programs
Background research together with survey and interview responses identified the following
formal training programs available to supervisors of students, trainees and interns.
Interview responses indicated that completion of this course is the basic level of supervision
training required of nursing facilitators by some educational institutions.
The Certificate IV in Workplace Training and Assessment is undertaken by those wishing to
develop skills in the training and assessment of competence in a workplace context. Core skills
covered by this course include:
• planning assessment activities and processes
• assessing competence
• assessment validation
• organisation and delivery of group-based learning
• organisation and facilitation of learning in the workplace
• designing and developing learning programs.
In NSW, this course is run by both TAFE NSW and private RTOs state-wide.
Studies in the education of health professionals
Background research identified a number of university-run formal training programs focused on
up skilling health professionals with educational responsibilities in the workplace.
Formal training courses available in health professional education identified include:
• Master of Education (Health professional education)
• Graduate diploma in education studies (Health professional education)
• Graduate certificate in education studies (Health professional education).
These courses are undertaken by those wishing to gain an understanding of internationally
recognised education pedagogies and practices for teaching and learning in a health context.
Core units of study covered by these courses include:
• clinical teaching and supervision
• teaching clinical reasoning
• assessment
• simulation-based learning in health.
In NSW, these courses are delivered through the University of Sydney. Similar Graduate
certificate courses are also run through Charles Sturt University and University of New England.
133
9.2.3 Existing informal training programs
Interview responses indicated that informal training courses are most commonly
implemented by a training institution prior to sending students on clinical placement, or
provided by the LHD at a facility level.
University-run informal training programs
Universities generally provide training to facilities prior to sending students on clinical
placements. It was noted in interviews, however, that this training is directed at updating
supervisors on the current clinical policies and procedures as opposed to focusing on mentoring
and supervisory skills.
“The University course is more directed at showing the supervisors what are the
current clinical policies and it’s largely clinically based, rather than mentor [or]
education-based.”
In nursing, it is common for universities to provide clinical placements with a facilitator who
oversees the supervision of students of clinical placements. This facilitator is generally employed
and trained by the university. On occasions where the facilitator is an internal member of staff at
the clinical placement, the university will invite the facilitator to take part in a training program.
In addition to facilitator training, universities may also provide training to Nursing Unit Managers
and Clinical Nurse Educators.
LHD-run informal training programs
Survey respondents and interview participants identified a number of seminars/workshops on
supervisory skills, run locally at a hospital level.
Seminars/workshops were identified in the following LHDs:
• Western Sydney
• Northern Sydney
• South East Sydney
• Nepean Blue Mountains
• Hunter New England
• Illawarra Shoalhaven
• Justice Health and Forensic Mental Health.
It should be noted, however, that respondents were not specifically asked to identify whether
their LHD delivers training programs in supervision – this information was volunteered rather
than sought. As such, this listing may not be reflective of all LHD-run training programs in NSW.
In addition, information regarding LHD-run training programs is not publicly listed. Therefore, the
accuracy of course names provided, as well as information regarding specifics of the courses
and currency of the courses cannot be verified.
Interview responses indicated the need for adoption at a hospital level of programs such as
’Train the trainer’ and ‘Teaching on the run’.
Teaching on the run
Teaching on the run is a program developed in Western Australia to help doctors increase their
confidence and skills for supervision and teaching in the clinical setting. The program has been
adopted in NSW across a number of disciplines. It takes the form of 6 modules, designed to be
delivered over a series of 2–3 hour workshops
134
Train the trainer
Train the trainer is a nationally evaluated program targeted at up-skilling staff members who do
not have formal education qualifications, but who may be involved in the training and
professional development of other staff members; interviews suggested that the Train the trainer
program is well adopted in NSW across a number of health disciplines.
9.3 FUTURE TRAINING IN CLINICAL SUPERVISION
9.3.1 Interest in undertaking clinical supervision training for supervisors
Survey feedback suggests there is interest among current supervisors in undertaking
training in supervision, with more interest in informal training such as LHD-based
seminars than formal training courses.
Current supervisors were canvassed to explore the level of interest in undertaking training to
support skills in supervision of students, trainees and interns.
Information about interest in undertaking training in supervision was provided by 1493 people
who are currently supervising students, trainees and interns. Of these:
• 731 indicated interest in undertaking formal training in supervision (Table 9.4); interest in
different types of formal training differed by discipline
• 1141 people indicated they were interested in undertaking informal training in supervision
(Table 9.5); interest was highest in undertaking seminar/workshop-based training, both
internally provided by the LHD or externally provided.
Table 9.4: Interest in undertaking formal training in supervision, by discipline*
Formal training
course
% of respondents
Allied
health
(n=352)
Dentistry
(n=16)
Medicine
(n=121)
Midwifery
(n=20)
Nursing
(n=222)
Total
(n=731)
Certificate IV in
Workplace Training
and Assessment
61.1
37.5
34.7
65.0
53.2
53.9
37.2
43.8
32.2
25.0
27.5
33.2
Graduate diploma
25.3
37.5
26.4
20.0
24.3
25.3
Master’s
19.0
31.3
38.8
30.0
32.0
26.8
Doctorate
8.0
12.5
8.3
0
8.1
7.9
*Percentages and totals are based on respondents. Some respondents indicated interest in more than one formal
training course
135
Table 9.5: Interest in undertaking informal training in supervision, by discipline*
Type of informal
training course
% of respondents
Allied
health
(n=587)
Dentistry
(n=18)
Medicine
(n=221)
Midwifery
(n=34)
Nursing
(n=281)
Total
(n=1141)
LHD-run
seminar/workshop
56.4
61.1
40.3
70.6
60.1
54.6
LHD-run course
39.2
38.9
19.9
38.2
42.7
36.3
External
seminar/workshop
58.6
44.4
53.8
67.6
48.8
55.3
External course
37.5
44.4
34.8
29.4
37.7
36.9
University-delivered
program
53.0
50.0
50.7
26.5
44.5
49.6
*Percentages and totals are based on respondents
9.3.2 Preference for the delivery for a clinical supervision training program
Survey and interview feedback suggests that training for supervisors of students,
trainees and interns should incorporate face-to-face components, such as
seminars/workshops.
A network of support for supervisors may be useful, to enable supervisors to learn from
Information about preferred mode of training was available from 1472 people who currently
provide supervision for students, trainees and interns in NSW Figure 9.1). While there were
some differences between disciplines, the preferred approaches for all disciplines were:
• seminars/workshops
• a mix of face-to-face and online learning.
Figure 9.1: Preferred mode of training in supervision (n=1472)
100
Formal training course
Seminar/workshop
Distance education
Online
Face to face and online
On the job training
90
% of respondents
80
70
60
53.7
50
40
43.8
33.6
30
20.2
20
14.5
18.3
10
0
136
The majority of interview participants also expressed a preference for face-to-face delivery of a
training program. While there was an acknowledgement that content could be delivered through
an online training module, the consensus was that face-to-face workshops or role playing is the
best way to learn the skills required of a supervisor, including reflection on practice.
“… they bring their prior knowledge and experiences and things like that and
share it with the rest of the group. Because we know the best way to learn those
type of things is hearing other people’s stories.”
It was suggested that a component of the training strategy could be to build a network of support
for supervisors, to enable supervisors to learn from each other’s experiences.
“There possibly needs to be a network of teaching support, so that person has
someone to go to talk to about the clinical teaching issues that they are facing
and why their students are or aren’t performing as well as they
would like them to.”
9.3.3 Barriers to accessing clinical supervision training for supervisors
Lack of time was identified as the primary barrier to attending training in supervision by
current supervisors of students, trainees and interns. Cost of training was a barrier for
more than half of allied health, nursing and midwifery supervisors.
Information about barriers to attending training in supervision was identified for 1496 people who
currently provide supervision to students, trainees and interns. Of these:
• lack of time was the major barrier identified (nominated by 83.4% of current supervisors)
• cost of training was nominated as a barrier by more than half of allied health, nursing and
midwifery respondents.
Other responses received through the electronic survey indicate the lack of an appropriately
targeted training course also prevents people from participating in further training.
Table 9.6: Barriers to accessing training for supervisors, by discipline*
Type of training
% of respondents
Allied
health
(n=730)
Dentistry
(n=28)
Medicine
(n=309)
Midwifery
(n=45)
Nursing
(n=384)
Total
(n=1496)
Time
82.1
67.9
93.9
80.0
79.2
83.4
Cost
59.6
28.6
32.0
53.3
58.3
52.8
Location
49.9
35.7
35.9
31.1
42.2
44.2
Limited awareness
34.5
32.1
28.2
33.3
28.1
31.5
Support/approval to
attend
30.7
42.9
24.9
37.8
35.4
31.1
*Percentages and totals are based on respondents
The challenge of finding time to attend training and to deliver training was also a recurring theme
throughout the interviews
137
Case example
A high proportion of university-based teachers, mentors and supervisors in dentistry are often
also private practitioners. Finding a suitable time for these people to attend training is quite
difficult. Training is often after hours, and this can be inconvenient or undesirable for people to
attend.
In addition, a high proportion of people who provide training to supervisors are also private
practitioners.
“A large majority of the university teachers or mentors or supervisors are often
external practitioners that come in a part-time capacity to teach under the
university umbrella. So it suits them better probably on a weekend because they
don’t have to leave their practices.”
.
9.3.4 Encouraging uptake of clinical supervision training for supervisors
Affiliation with professional colleges and introduction of training as a component of
professional awards may be incentives for participation in training for supervisors.
Interviews suggest there appears to be little accreditation or governance that formalises
the skills required for supervisors.
A number of interview respondents offered suggestions on ways to incentivise participation in a
training program, including:
• affiliation with professional colleges and the incentive of continuing professional
development points may encourage participation in a training program
• introduce the completion of training into the professional awards.
“I think just raising the profile and the recognition for staff who take on those roles
is probably important, and I’m not talking about monetary-wise necessarily; we do
have in the health professions award, we do have specific positions who are
graded for students, and I think they’re good because it does allow someone as a
career step to take on student supervision full-time.”
Interview participants reflected on the lack of governance around supervision for students,
trainees and interns, suggesting that a greater level of scrutiny around those providing
supervision may be a driver for education and training in this area.
9.4
IMPORTANCE OF CONTEXT FOR CLINICAL SUPERVISION TRAINING PROGRAMS
9.4.1 Guiding principles of a training approach for supervision of students, trainees and
interns
Interview feedback suggests a training strategy to increase capacity for supervision of
students, trainees and interns should be equitable and flexible, and focus on a
supervisor’s skills in supervision as well as their clinical knowledge.
Interview feedback provided some views on principles that should underpin a training strategy to
increase capacity for supervision of students, trainees and interns. These included:
• the need for an equitable and flexible approach to training, to meet individual needs and to
bring people to a minimal level of competency
• the importance of avoiding encouraging a prescriptive approach to teaching and
supervision
• recognition that a ‘one-size-fits-all’ approach will not work
138
• the need to identify those areas of supervision that can be influenced through a training
program and those that will make the greatest difference to supervision capacity
• the importance of focusing on ‘supervision’ skills as well as clinical skills, such as reflective
learning
“There would be a large personal reflective component to understand how it is
that you teach because of the way you have learned to teach… and to really
understand the learning needs of people in the system.”
• the potential benefits of encouraging supervision training to be conducted in an
interdisciplinary setting.
9.4.2 Contextual differences
Interview and survey feedback highlighted that a training strategy to increase capacity for
supervision of students, trainees and interns should recognise and reflect the contextual
differences that influence provision of supervision, including differences based on
discipline, location and service setting.
Interview responses highlighted the importance of considering contextual differences when
planning and implementing a training strategy to increase capacity for supervision of students,
trainees and interns. One case example of context-specific considerations to be taken into
account for general practice is provided below.
General practice
Placements of students, trainees and interns within general practice not only involves patient
interaction, but also involves exposure to unique aspects of general practice including managing
the Medicare system and working with the general practice team.
“It’s pretty much up to each individual supervisor what they do with the student …
they’re certainly being encouraged to get students specifically involved in
interviewing the patients and examining the patients so they’re not just sitting in
the corner of the room … they’re also of course learning about all aspects of
general practice such as the fact that we deal with Medicare, privately, we do
chronic disease management, we do procedures, we do counselling and they
meet the general practice team.”
Interview feedback suggested that a context-specific training strategy may help to increase the
capacity and willingness of general practice to undertake supervision.
“I think that teaching the GPs some actual supervision skills, that it doesn’t have
to be all about the student being passive but getting the student to be actively
involved, would be really useful.”
As such, content of a supervision training program directed at supervisors in general practice
should include practical advice related to providing supervision in private business.
“We need to recognise that general practice is a different context to hospitals. So
general practice is the run of private businesses in general and… when people
are teaching students they’re generally taking time out from their own clinical
consultation time.”
139
Suggestions included how to build supervision time into everyday practice so that supervision
does not impact adversely on clinical/business time such as involving students in:
• auditing clinical problems
• writing up records
• taking a history or examinations
• spending time with other team members.
9.5 OTHER ISSUES INFLUENCING CAPACITY
Other issues that may influence approaches to increase capacity include regional
resources, differences in remuneration for supervisors between disciplines, evaluation of
supervisor roles and interdisciplinary supervision.
Other relevant issues relating to capacity for supervision and integration of supervision
approaches included:
• recognising that the number and skills of supervisors represent only one factor affecting
capacity for student placements; for example, in regional areas, accommodation
availability can influence the number of placements offered
• differences between disciplines in how people providing supervision are remunerated
• the need to build in approaches to evaluate supervisor roles.
9.5.1 Interdisciplinary supervision
Some feedback about interdisciplinary supervision was also identified through this project.
Feedback highlighted the importance of:
• recognising the value of interdisciplinary supervision, so that supervisor roles are not
limited to individuals within the same role as the person being trained
• finding ways to ‘sell’ or ‘market’ the benefits of supervision not only as a formal
requirement of student, trainee and intern training but as a way of ensuring patient safety
and quality of care
• recognising that student, trainee and intern placements are more than short-term
educational opportunities, but in many cases contribute to the experience that influences
staff recruitment and retention, particularly in rural or regional areas.
140
10. PROFILE OF THE SUPERVISION OF STUDENTS, TRAINEES AND
INTERNS IN THE PRIVATE HEALTH SECTOR
Key findings
• Overall, the profile of supervisors of students, trainees and interns in the private sector
is not dissimilar to the profile of supervisors of students, trainee and interns in the
public sector.
• Supervision is not provided to all students, trainees or interns from all disciplines in the
private health sector.
o
Dental students do not undertake clinical placements in private health facilities
o
Medical interns (PGY1) do not undertake prevocational training in private
health facilities, with the exception of general practice, on occasion.
• The organisation and scheduling of supervision within the private health sector can
differ from the public sector. However, the day-to-day management of supervision is
comparable in both sectors.
• The maintenance of a strong relationship between educational institutions and private
health facilities is vital to engaging the capacity of supervisors of students, trainees
and interns in this setting.
• Supervisors of students and trainees in private health facilities are generally employees
of the private health facility (i.e. not externally provided by the educational
institutions).
• Recognition for the role of a supervisor is varied in the private health sector.
Supervision of junior staff, students and trainees is typically expected of senior health
professionals.
• Supervisors of students and trainees in the private sector do undertake training to
support their role as supervisors. This training, which may be initiated by the
educational institution or the private health facility, is comparable in the training
undertaken by supervisors in the public sector.
• Certificate IV in Workplace Training and Assessment was identified as the most
commonly completed supervisor training.
• The experience and skills of supervisors in the private health sector do not differ greatly
from those in the public health sector.
• Clinical skills and knowledge was identified a core skill required by supervisors of
students and trainees.
• Remediation of underperforming students was identified as one area in which
supervisors would like additional training.
• Critical thinking skills and balancing supervision requirements with business needs are
two skills identified as important within workplace contexts common to the private
health sector.
• There is no common approach to funding private health supervisors or facilities to
provide supervision of students and trainees.
• The capacity of the private health sector to provide supervision is dependent on the
capacity and receptiveness of the private health facility to take on the commitment of
supervision, as well as the capacity and receptiveness of the supervisors within the
facility.
• All of the private health facilities interviewed during this profile indicated that they were
receptive to taking on supervision of students and trainees.
141
• Supervisors are generally receptive to providing supervision to students and trainees.
• Capacity of private health facilities to take on supervision could be enhanced by
staggering the scheduling of clinical placements from different educational
institutions, and providing additional funding to train clinical supervisors.
• More than half of survey respondents who identified as providing supervision to
students or trainees in the past 12 months indicated that they do not have capacity to
provide more supervision.
• Low supervisor-to-student ratios and difficulty finding a balance between service
delivery and teaching were identified as capacity-limiting factors.
• Current supervisors in the private health sector indicated a preference for face-to-face
supervisor training, with an emphasis on case study or scenario-based learning.
• Commonalities between supervisors in the private and public health sectors suggest
that any training strategy developed to enhance the capacity of supervisors in the
public health sector would be applicable and well-received by supervisors in the
Following completion of the NSW CSSP mapping study in the NSW public health sector, HETI
commissioned ZEST Health Strategies to further extend the study into the NSW private health
sector.
The purpose of the study extension was to develop a profile of student, trainee and intern
supervision within the private sector, identify any potential capacity for uptake of clinical
supervision within this sector, and the tools and resources required to harness this capacity.
This profile of supervisors of students, trainees and interns in the private health sector is
inclusive of allied health, dentistry, medicine, midwifery and nursing. However, it should be noted
that the private health sector may not provide supervision to all levels of students, trainees and
interns for all disciplines outlined above. The extent of supervision in the private health sector is
defined in Section 10.3.1.
10.1 PRIVATE HEALTH SECTOR OVERVIEW
Services
The private health sector plays a significant role in the delivery of health care services in
Australia. Data published by the Organisation for Economic Co-operation and Development
(OECD) indicated that, in 2006, 32.3 per cent of Australian health system expenditure was
attributable to the private health sector. 8
Private health facilities are privately owned and managed services. As such, they differ greatly in
size and function. The private health sector in Australia encompasses a broad range of services,
including:8
• private hospitals and residential aged care facilities; including for-profit and not-for-profit
institutions
• general practice
• specialist medical services
• pathology and diagnostic imaging services
8
The impact and cost of health sector regulation. Australian Centre for Health Research. Available from
http://www.achr.com.au/pdfs/The%20Impact%20and%20Cost%20of%20Health%20Sector%20Regulation%20-%20FINAL.pdf
[Accessed June 2012].
142
• allied health services, including dental, optometry and optical dispensing, chiropractic,
osteopathic and physiotherapy services
• other health services, including ambulance and transport services
• community services.
Private hospital facilities are classified by the Australian Institute of Health and Welfare (AIHW)
as either acute or psychiatric hospitals, or free-standing day hospitals. This classification has
been applied to this overview.
Acute private hospitals provide some medical, surgical or obstetric care, together with
associated allied professional services and round-the-clock nursing care. Free-standing day
hospitals focus on a small number of procedures, such as investigation and screening services,
and general day surgery. 9
Private hospital workforce
Data regarding number of facilities and staff are available for private hospital facilities in NSW.
In 2010–11, there were 177 private hospital facilities in NSW. Of these, 86 facilities were acute
or psychiatric hospitals and 91 facilities were free-standing day hospitals. 10
In 2009–10, for-profit companies, such as Ramsay Health Care and Healthscope, operated 67
acute or psychiatric private hospital facilities in NSW. The remaining 19 acute or psychiatric
private hospital facilities were operated by not-for-profit organisations, such as Catholic Health
Australia. 11
In 2009–10, private acute and psychiatric hospitals employed over 13,000 full-time equivalent
staff. An additional 944 full-time equivalent staff were employed in free-standing day hospitals. A
numerical breakdown of full-time private hospital employees in NSW is provided in Tables 10.1
and 10.2.
Table 10.1: Numerical breakdown of the health workforce employed at acute or
psychiatric private hospitals in NSW, 2009–10
N
%
Registered nursing staff
6,264
46.8
Other nursing staff
1,270
9.5
Salaried medical officers and other
diagnostic health professionals
1,024
7.6
Administrative and clerical
1,968
14.7
Domestic and other staff
2,863
21.4
Total
13,388
100
9
Productivity Commission 2009, Public and Private Hospitals, Research Report, Canberra.
Australian Institute of Health and Welfare 2012. Australian hospital statistics 2010–11. Health Services Series no.43. Cat. no. HSE
117. Canberra: AIHW.
11
Australian Bureau of Statistics 2011. Private Hospitals 2009–10 (4390.0) Canberra
10
143
Table 10.2: Numerical breakdown of the health workforce employed at free-standing day
hospitals in NSW, 2009–10
N
%
Nursing staff
522
55.3
Administration and clerical
294
31.1
Other*
128
13.6
Total
944
100
* Includes salaried medical officers and other diagnostic health professionals, domestic and other staff
Increasing teaching role
Traditionally, clinical placements and supervision of students, trainees and interns has been
provided by the public health sector. However, a review of the relative performance and
services in Australian public and private hospitals conducted by the Productivity Commission
in 2006–07 identified:
• 47 private hospitals throughout Australia providing some form of teaching to medical
staff and undergraduate students9
• 171 private hospitals throughout Australia providing some form of teaching to nursing
staff and undergraduate students.9
Further details regarding these teaching roles within private hospitals are provided in Table
10.3. Please note that this data is representative of teaching roles Australia wide. No statebased breakdown was provided.
Table 10.3: Acute and psychiatric private hospitals in Australia providing teaching
services, 2006–07*
Private hospital teaching status
n
Medical staff/undergraduates
47
Nursing staff/undergraduates
171
Allied health professionals
61
Affiliated with training institution
64
Total
343
* No state-based breakdown available
Dental workforce
The dental workforce in NSW comprises dentists, dental specialists and allied practitioners,
including dental hygienists, dental therapists, oral health therapists (dual-qualified hygienists and
therapists) and dental prosthetists.
A Dental Labour Force Collection undertaken by the Australian Research Centre for Population
Oral Health in 2006 on behalf of the Australian Institute of Health and Welfare (AHIW) indicated
that, at that time, there were 3,561 practicing dentists in NSW. 12 Of these, almost 85 per cent
indicated that they work in the private health sector. A listing of the private dental workforce is
provided in Table 10.4.
12
Balasubramanian M & Teusner DN 2011. Dentists, specialists and allied practitioners in Australia: Dental Labour Force Collection,
2006. Dental statistics and research series no. 53. Cat. no. DEN 202. Canberra: AIHW.
144
Table 10.4: Numerical breakdown of the dental health workforce employed in the NSW
private sector, 2006*
Dental discipline
n
Practicing dentists
2,998
Dental hygienists
136
Dental therapists
15
Oral health therapists
35
Dental prosthetists
311
Total
†
3,375
* Figures are estimates only based on data collection by AIHW via a questionnaire to all dental practitioners. Not all
registered practitioners responded to the questionnaire.
†
Does not include dental specialists.
General Practice workforce
A review of health care services in the private sector by the Australian Bureau of Statistics
identified approximately 61,653 registered health professionals working in a general practice
medical business during the 2009–10 financial year. Registered health professionals employed
by general practice medical businesses included general practitioners, nurse practitioners,
registered nurses, enrolled nurses, and other health practitioners such as dental practitioners,
physiotherapists and psychologists. A listing of the general practice workforce in Australia is
provided in Table 10.5.
Table 10.5: Numerical breakdown of the general practice workforce in Australia, in 2009–
10*
General practice discipline
General practitioner
Nursing staff
†
n
36,392
10,981
Other health practitioners
14,280
Total
61,653
* No state-based breakdowns available
† Nursing staff includes nurse practitioners, registered nurse and enrolled nurse. No breakdown available
Allied health workforce
A 2009–10 review of health care services in the private sector by the Australian Bureau of
Statistics identified allied health professionals employed in private business in optometry and
optical dispensing; physiotherapy services; chiropractic and osteopathic services; and other
allied health services. A listing of the general practice workforce in Australia is provided in Table
10.6.
145
Table 10.6: Numerical breakdown of the permanent allied health workforce in Australia, in
2009–10*
Allied health discipline
n
Optometry and optical dispensing
7,789
Physiotherapy services
9,743
Chiropractic and osteopathic services
4,462
Other allied health services*
20,190
Total
42,184
* No state-based breakdowns available
†
‘Other allied health services’ not defined
10.2 PROFILE OF STUDENT, TRAINEE AND INTERN SUPERVISION IN THE PRIVATE
HEALTH SECTOR
Profile overview and objectives
The primary objectives of the private health sector profile were to:
• develop an overview of student, trainee and intern supervision within the private sector,
addressing:
o how clinical placements are organised in the private sector
o the relationship between private facilities and training institutions
o the capacity of the private sector to undertake student, trainee and intern supervision
o barriers or factors influencing the private sector uptake of student, trainee and intern
supervision
• develop a profile of student, trainee and intern supervisor skill level and experience;
including training programs completed
o identify supervision training programs specific to the private sector
o identify accreditation standards and employer policies specific to the supervision of
student, trainee and intern supervision within the private sector.
The private health sector profile focused on the supervision of students, trainees and interns
undertaking clinical placement within the following disciplines in a private health facility in NSW:
• allied health
• medicine
• midwifery
• nursing.
It was acknowledged that the private health sector in NSW encompasses a broad range of
services, as outlined in Section 10.1. For the purposes of this private health profile, focus was
limited to the following private health facilities:
• private acute hospitals, including for-profit and not-for-profit institutions
• community-based health service providers, such as residential aged care or community
mental health organisations
• private practice, including general practitioners, dental and allied health practices.
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Methods and information sources
This profile contains information obtained using the following methods:
• targeted internet-based background research
• consultation with key informants from private health facilities and organisations, and
educational institutions via;
o scoping discussion
o semi-structured interviews
o electronic survey.
Background research
Background research was undertaken to gain an understanding of how and where student,
trainee and intern supervision occurs within the private health sector.
Internet-based background research was conducted to identify:
• services provided in the private health sector
• different types of private health care providers
• private health sector workforce statistics.
In addition, publicly available information was sourced from educational institutions regarding the
organisation of, and procedures for, student clinical placements.
Scoping discussions
Initial scoping discussions were conducted with key informants to determine:
• the relationship between training institutions and private sector facilities
• expectations of private sector interview participants (e.g. whether honoraria payment
would be expected)
• additional contacts for interviews
• any possible pathways for survey dissemination.
Scoping discussions were conducted with 2 key informants from training institutions, and 1 key
informant from a private health association. Contact reports recording key points from these
initial scoping discussions were developed. Information contained in these contact reports has
been drawn on in the development of this profile.
Semi-structured interviews
Semi-structured telephone interviews were conducted with key informants to provide an
overview of the organisation of student, trainee and intern supervision within the private health
sector.
Key informants were identified through a variety of means as outlined below.
• ZEST Health Strategies identified contacts involved in the clinical training of students at a
number of educational institutions, known from previous work.
• HETI provided a comprehensive listing of contacts within non-government organisations.
This listing was compiled through input from the Project Advisory Committee. A review of
this listing was conducted to select contacts employed in positions most likely to inform
this profile.
• Key informants involved in scoping discussions identified colleagues who they felt would
be well-placed to inform this profile.
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• Internet-based background research identified contacts involved in the organisation of
clinical placements for students from both educational institutions and private hospitals.
In total, 23 identified key informants were approached to take part in an interview. Three key
informants took part in scoping discussions outlined above. Of the remaining 20, 12 took part in
interviews, 2 indicated that they were unavailable for an interview but were happy to complete a
questionnaire, 2 declined and a further 7 did not respond after three reminder invitations.
Key informants were a mix of representatives from educational institutions and professionals
involved in workforce development at key private facilities.
An interview schedule was developed based on the interview schedule used during the public
health sector mapping study. Interview questions focused on:
• understanding how student, trainee and intern supervision is organised between training
institutions and private health facilities
• understanding how supervision is conducted at private health facilities
• identifying skills required by supervisors of students, trainees and interns
• identifying skills or requirements for supervisors which are specific to the private health
context
• assessing the capacity and interest of private health facilities to take on clinical
placements.
Participants were provided with questions prior to their interview. The interview schedule is
included in Appendix X.
Two key informants who were approached to participate in a semi-structured telephone interview
were unable to do so. As an alternative, these key informants were provided with the interview
schedule as a questionnaire, to complete and return in their own time.
Additional sources of information
Interview data collected during the public health sector mapping study was reviewed for its
relevance to the private sector profile. Two interviews were identified as containing information
relevant to the private sector. Relevant key findings have been included in this profile.
Electronic survey
Following completion of the semi-structured telephone interviews, it was decided that further
input was required from the health professionals actually providing the supervision to students,
trainees and interns in the private health sector.
As such, a short electronic survey was developed based on the original electronic survey used
during the public health sector mapping study. A copy of the survey is provided in Appendix XI.
The survey was disseminated among some of the key informants involved in the semi-structured
interviews, for distribution among their staff networks. In total, four private health organisations
agreed to disseminate the survey among staff, across multiple private facilities. In addition, the
Australian Private Hospitals Association agreed to promote the survey through its state-based
newsletter.
The survey remained open for a period of 15 days.
In total, 28 health professionals responded to the electronic survey. Of those:
• 4 indicated that they were allied health professionals
• 3 indicated that they were medical professionals
• 21 indicated that they were nursing professionals.
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No responses were received from dental or midwifery professionals. This discipline breakdown
of respondents should be considered when reviewing survey responses.
The responses from the survey have been incorporated throughout this chapter. Due to the
small number of respondents from each discipline, data are reported as total responses and are
not broken down by discipline.
Data analysis
Data collected through scoping discussions, semi-structured interviews and questionnaires were
analysed to inform this profile. Contact reports, interview transcripts and questionnaires were
coded using NVIVO9 software to identify key themes and findings.
10.3 OVERVIEW OF SUPERVISION IN THE PRIVATE HEALTH SECTOR
10.3.1 Provision of supervision in the private health sector, by discipline.
Supervision is not provided to all students, trainees or interns from all disciplines in the
Dental students do not undertake clinical placements in private health facilities.
Medical interns do not undertake prevocational training in private health, with the
exception of general practice, on occasion.
Interviews with key informants indicate that supervision is not necessarily provided to all
students, trainees or interns from all disciplines in the private health sector. An overview of the
supervision provided in each discipline is outlined below.
Allied health
Allied health professionals working in a private health setting do provide supervision to allied
health students and trainees undertaking clinical placements. Examples of private settings in
which supervision is provided include private physiotherapy, speech pathology or occupational
therapy practices in the community.
Allied health professionals working in a private health setting may also supervise allied health
trainees in their first year after graduation, as the trainee completes standard requirements for
registration.
Dentistry
Dentistry professionals working in private practice typically do not supervise dental students.
During their degree, dental students undertake clinical placements in a public health setting.
Dentistry professionals working in private practice may provide supervision to dental interns in
their first year following graduation (PGY1).
Graduates from Australian Dental Council accredited dental programmes are required to
complete a PGY1 program in order to meet the Dental Board of Australia’s requirements for
registration. The PGY1 program involves rotation through general dental practice and hospital
clinics as well as other elective rotations. This can be undertaken in a private setting; however
priority is given to placing PGY1 interns in the public sector due to the great need for public
dental care in Australia.
Medicine
Medical professionals working in a private setting typically do not provide supervision to medical
students, as most clinical placements are undertaken in a public health setting. There are two
circumstances in which medical professionals may provide supervision to medical students in a
private health setting.
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1. General practitioners supervising medical students undertaking clinical placement in a
private general practice.
2. Consultants or specialists supervising medical students undertaking part of a placement
block in a private hospital due to the availability of clinical material or medical procedures.
Case example
One interview conducted with a key informant involved in the clinical placement of medical
students indicated that undergraduate medical students may undertake part of a placement
block in a private hospital, due to the availability of clinical material.
Typically, this occurs when the consultant or specialist by whom the student is supervised works
across both a public and private facility. The medical student will be allocated such a placement
in order to gain exposure to particular procedures that fall under a unit of study, but may not
occur, or may occur less frequently, in the public setting. A thyroidectomy was one such
procedure mentioned.
Medical professionals working in a private hospital setting do not provide supervision to medical
interns in their first year following graduation (PGY1). PGY1 medical interns undertake a
prevocational internship within the NSW public health system. Internships are allocated across
15 prevocational training networks. Private health facilities are not included in these training
networks.
During their prevocational training years, medical trainees may choose to enter a private general
practice setting. This occurs as part of the Prevocational General Practice Placements Program
(PGPPP). The PGPPP generally targets PGY2 and PGY3 medical trainees. However, there is
flexibility for PGY1 interns to take part, subject to review by the Postgraduate Medical Education
Council in NSW.
In this circumstance, accredited general practitioners working in a private setting are required to
provide supervisions to medical interns. These interns undertake a 10–11 week rotation with an
accredited GP training practice.
Nursing and midwifery professionals are required to provide supervision to students and trainees
undertaking clinical placements in private health facilities. Examples of private health settings
may include private acute and maternity hospitals, or community-based aged care facilities.
PLEASE NOTE: Due to the limited nature of the provision of supervision to dental and medical
interns in the private sector, this profile will refer purely to ‘trainees and interns’ for all disciplines,
unless otherwise stated.
10.3.2 Circumstances in which private health facilities become involved in student and
trainee supervision
Supervision may be provided in a private health facility due to a need for additional
capacity, exposure to unique clinical material or conveniently located placement sites for
students, trainees and interns. The private health facility may also take on student or
trainee supervision due to the potential for future recruitment.
Interviews identified a variety of circumstances in which private health facilities may be involved
in the supervision of students and trainees undertaking a clinical placement. These
circumstances are outlined in Table 10.6 below.
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Table 10.6: Skills required by supervisors of students, trainees and interns identified by interview
respondents
Reason
Detail
A source of additional
capacity
• Certain disciplines and educational institutions require a set ratio
of supervisors to students on clinical placement.
• Private health facilities may be used as an additional source of
capacity to ensure student to supervisor ratios are maintained.
• For example, as reported in Chapter 8, supervision of nursing
students and trainees is conducted on a 1 facilitator to 8 student
ratio, and a 1 preceptor to 1 student ratio.
• Interviews with key informants involved in the organisation of
clinical placements for nursing students and trainees indicated
that private health facilities are used ‘not instead of, but as part of
the capacity’.
Availability of unique
clinical material
• Private health facilities can be a source of unique or relevant
clinical material as these facilities may provide services, or
conduct procedures, not undertaken in a public setting.
• Clinical placements are matched to part of a course curriculum.
Access to clinical material relevant to a course curriculum may
require students, trainees or interns to undertake a placement in
a private health facility.
• Mental health was one specialty area for which private health
facilities may be targeted for their unique clinical focus.
“… the main area has been looking at increasing our capacity for
mental health. And not only the capacity but also the actual
experience for mental health … our curriculum has asked us
really to look at those areas [private health facilities]’
• Nursing, social work or psychology students are often sent to
community-based mental health care services are run by private
for-profit or not-for-profit organisations for clinical placements.
“In public health, you’ve got acute and sub-acute, then you have
really a combination of not-for-profit facilities that provide support
for mental health patients or people that have mental illness.”
Location and convenience
for students, trainees and
interns
• Private health facilities may be approached to undertake clinical
placements of students, trainees and interns due to the
convenience of their location. Factors influencing this decision
may include:
o large distances between neighbouring towns
o student preference not to travel
o high costs associated with travel and accommodation.
“We would look more geographically and say, this is a good place
for our students to go, what are options are there for students in
this area?”
Interest in future
recruitment by private
health facilities
• Private health facilities are receptive to taking on students and
trainees in clinical placements as they feel that providing
supervision to students and trainees from the local area may
assist in recruitment and staff retention.
“We try and partner with the TAFE that’s in the vicinity of the
hospitals because then it makes sense for future recruitment that
generally those students live in that area, are obviously going to
be seeking employment in that area.”
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10.3.3 Identifying supervision potential in a private health setting
Private health facilities may be approached by an educational institution, or an individual
student themselves, to provide student or trainee supervision. Alternatively, the private
health facility or health professional may approach the educational institution to express
interest in providing supervision.
Interviews indicated that there are a number of ways in which a private health facility and health
professionals working in a private setting may become involved in supervision of students and
trainees. These approaches are outlined in Table 10.7 below.
Table 10.7: Ways in which private health facilities and professionals may become involved in
supervision
Approach
Detail
Educational institution
approaches private health
facility
• The most commonly identified means of engagement of private
health facilities in supervision of students and trainees was by
direct approach from the educational institution.
• Available private facilities may be identified through research,
word of mouth or cold-calling.
“You have to go through the process of contacting those facilities.
Now you can do it cold … in some cases (we may) have a staff
member … involved in research or something. So you may go
through some form of introduction or you might just do it cold.”
Private health facility
approaches educational
institution
• Some private health facilities indicated that they seek out
affiliation with local educational institutions as a means of future
recruitment.
Individual
supervisor/clinician
approaches educational
institution
• Educational institution may engage potential supervisors of
students, trainees and interns via their website.
“Supervisors apply online and send in additional information. This
collects supervisors’ demographic details and information about
the placement requirements, types of patients seen, nature of the
work, placement setting, required preparation, level of training
required for the placement etc.”
• Supervisors are encouraged to apply online, and indicate their
experience with student and trainee supervision. This method of
application is usually completed by smaller, community-based or
private practice facilities.
Individual student
approaches a private health
facility
• Interviews conducted with both a private hospital and a
community-based private health organisation indicated that
students from allied health and nursing disciplines have been
known to contact the facility directly to express interest in
undertaking a clinical placement.
“It’s usually the student that approaches us. We ensure that the
objectives that the students have are able to be fulfilled within our
organisation in some way.”
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10.3.4 Organisation of the supervision of students and trainees in a private health setting
The organisation and scheduling of supervision within the private health sector can differ
from the public sector. However, the day-to-day management of supervision is
comparable in both sectors.
Liaison and administration
Once a private health facility has been identified as a potential site to provide supervision to
students and trainees, it is important that the educational institution investigates and inspects the
facility to ensure it is appropriate.
The requirement for the educational institution to review the facility was a common theme in
multiple interviews conducted with key informants from a variety of disciplines.
“… there’s some making appointments, going out and seeing the places, sussing the
placements and the type of placement we’re looking for … discussing this with the unit of care
coordinators or the lecturer in charge of a relevant unit to see how that matches up.”
Point of comparison with the public health sector
The need for a site visit to determine the appropriateness of a public health site for clinical
placements was not raised during the public sector mapping study.
Background research indicates that public hospitals involved in the prevocational internship
program for medical interns need to be accredited. In addition, some professional registration
boards, such as the Nursing and Midwifery Board of Australia, have begun to implement clinical
site visits prior to approving a program of study run by an educational institution.
Little information is available about the assessment of other public health sites by educational
institutions. It could be assumed that the relationships between educational institutions and
public health facilities are well established, and therefore no site assessment is required.
The review ensures that the facility has:
• the capacity to undertake student or trainee supervision
• clinical material relevant to units of study
• sufficient patient flow and clinical material to fill the student and trainee placement.
Once a facility has been assessed for appropriateness, the educational institution typically
develops a memorandum of understanding (MOU) or service agreement with the private facility.
“Once you start going outside of the health department or the Ministry of Health, and you’re
looking at private NGOs etc, then you have to look at individual memoranda of understanding or
student placement agreements. So it’s therefore done on an individual basis.”
MOUs outline the requirements and expectations of both the educational institutions and the
private health facility with regard to the clinical placement. They cover insurance details of the
student, trainee or interns on the clinical placement. They may also outline any funding of
training agreements between the two parties.
Interviews indicate that MOUs are common in nursing and midwifery, while they are not a
requirement for allied health placements. Private allied health practices do, however, receive
information packs from the educational institution outlining the requirements and objectives for a
student’s placement.
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Point of comparison with the public health sector
While the public sector mapping study did identify the need for individual student
agreements, there was little mention of MOUs or written agreements between educational
institutions and public health facilities.
Background research indicates that agreements are required in the public health sector by
both the educational institutions and by the NSW Ministry of Health.
Scheduling of clinical placements
Prior to the launch of Clinconnect in July 2012, the scheduling of clinical placements was
conducted in the same way for public and private health facilities. That is, educational institutions
would email their scheduled clinical placement dates for the following year to health facilities.
The health facilities would then indicate their availability to take on placements and an
arrangement would be made.
The introduction of Clinconnect means that from 2013, educational institutions will need
separate facilities to organise and manage the scheduling of clinical placements in public and
private facilities.
Point of comparison with the public health sector: Clinconnect
The advent of Clinconnect has brought the public health facilities into a centralised web-based
management system. The system was designed to enhance efficiency and provide greater
transparency in the organisation of clinical placements.
As a result, educational institutions are now required to use separate systems to organise
clinical placements in the public and private sector.
“We have no choice but to run two completely separate, interrelated but separate, systems
because … we get our offer forms in from the private sites and enter them into our database and
at the moment we will still have to get our offers from Clinconnect, put them into our database,
then later on once the student is allocated, put that information back into Clinconnect.”
Interviews with educational institutions indicated that the management of two systems for
organising clinical placements can be an extra burden on time and resources.
“… all that time involved there is really just dead time, when you could instead be using it to
support students more and support sites more … improve relationships and work more on the
quality of what’s being offered, but instead … there’s this potential to really get quite caught up in
juggling with systems”
Educational facilities also expressed concerns over the impact Cliniconnect may have on the
established relationships with private health facilities.
“ … you don’t (want to) over request New South Wales Health sites because if you do you will
obviously use them at the detriment of private sites and you don’t want to lose those (private
site) offers because you know we don’t really have overall the capacity to do that.”
Interviews with private health facilities also indicated that some facilities are concerned about the
impact that Clinconnect may have on their intake of students and trainees. Under Clinconnect,
educational institutions allocate placements and shift preferences for their students. Private
health facilities will not be able to offer this same service.
“We’re not included in that (Clinconnect) which makes it difficult for … the students … because
we just allocate them shifts. They know the days they come but we allocate them shifts.”
“It’ll be interesting to see whether we have a decline in students wanting to come here because
they don’t get that flexibility to organise their own rosters.”
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Day-to-day management of clinical placements
Interviews indicate that the day-to-day liaison with private health facilities involved in the
supervision of students and trainees does not differ from the public setting. The clinical
placement liaison personnel employed by educational facilities to manage placements work with
both public and private facilities.
Comments from staff involved with student or trainee clinical placements in private facilities
reflected the importance of having a key contact at the educational institution.
“We know whoever organises the clinical placements certainly at the three universities, that if
we’ve got any problems we can certainly contact them and they get back very quickly to us.”
“We have key contacts, yes, that’s we’re in touch with all the time. If we have an issue with a
student or anything it’s very easy to get in contact with whoever the key person is.”
10.3.5 Maintaining the relationship between educational institutions and private health
facilities
The maintenance of a strong relationship between educational institutions and private
health facilities is vital to engaging the capacity of supervisors of students and trainees
in this setting.
The maintenance of a strong relationship between educational institutions and private health
facilities is vital to engaging the capacity of supervisors of students and trainees in this setting.
“… (you have) got to be there, got to be seen, you’ve got to be contactable and they like to see
your face. They need you to visit, that’s what they like.”
Maintaining open communication, and clear understanding of student requirements, assists in
the scheduling and planning of student and trainee clinical placements. It also helps ensure the
supervisor is well-informed and prepared to take on the supervision, resulting in a better
experience for the student or trainee.
“We work in conjunction with the student, the Uni, to make sure that those objectives are met
and usually we meet quite regularly with the representatives from the Uni.”
Maintaining a good relationship enables the supervisor to communicate freely with the
educational institution if there are any problems or concerns regarding the student or trainee.
“I think we have a good relationship with them. We know whoever organises the clinical
placements certainly at the three universities, that if we’ve got any problems we can certainly
contact them and they get back very quickly to us”
For the private health facilities, working collaboratively with educational institutions can benefit
their staff, with opportunities and partnerships for continued education.
“I go to many meetings with the TAFE when they’re actually putting together their training
packages, because they’re actually getting some industry input into it. Which I found has been
really beneficial and not only that it’s opened up other avenues for us. We have good
partnerships with postgrad studies for our staff with certain universities and the college of
nursing.”
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10.4 PROFILE OF SUPERVISORS OF STUDENTS, TRAINEES AND INTERNS IN THE
PRIVATE HEALTH SECTOR
Information regarding supervisors of students, trainees and interns in the private health sector
was compiled from interviews with key informants, and responses to a survey targeted at
supervisors themselves.
Findings from these profiling methods indicate that the characteristics, experience and skills of
supervisors in the private health sector do not differ greatly from those in the public health
sector.
This section outlines these commonalities, and highlights some specific differences, with the aim
of informing a strategy for enhancing the capacity of supervisors in the private health sector.
10.4.1 Supervisors of students and trainees in the private health sector
Supervisors of students and trainees in private health facilities are generally employees
of the private health facility (i.e. not externally provided by the educational institution).
Interviews indicate that supervisors of students and trainees in private health facilities are
generally employees of the private health facility. This arrangement is dependent on the
discipline, and on the agreement between the educational institution and the private health
facility.
The majority of interviews indicated that supervisors of students, trainee or interns are typically
staff employed by the private health facility. This is comparable in the provision of supervision in
the public setting.
A key implication of this arrangement is the need for the facility and/or the educational institution
to ensure supervisors are adequately trained to provide supervision to students and trainees.
Training of supervisors in the private health setting is explored in further detail in 10.4.3.
Case example – Nursing
Interviews conducted with 3 separate private health facilities indicated that it is the preference of
the private health facilities to have internal facilitators for the supervision of students and
trainees.
“We try and use all our own staff for facilitating but sometimes when it’s too busy and so forth
they don’t get released and the universities have to provide an external facilitator.”
One reason given for this preference was that internal facilitators are more familiar with the site,
and this benefits the student during the placement.
“The students learn so much more with the facilitator that’s here because they’re up to date on
policies and procedures …. We certainly notice the gaps between having our own facilitator
who’s part of the hospital as opposed to an external facilitator coming in.”
In some cases, the educational institution will send a representative to the private health facility
to help assess a student or trainees progress. This is, once again, comparable in the procedure
in the public setting.
“For external placements a university staff member attends the unit where the student is placed
to conduct interviews regarding the placement experience and student’s progress.”
“Sometimes the Uni will send somebody to … do the assessment of how things are progressing
… the student usually has some objectives that they need to achieve in the placement and so
we kind of work in conjunction with the student, the Uni, to make sure that those objectives are
met and usually we meet quite regularly with the representatives from the Uni.”
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Case example – Medicine
An example of when the provision of supervision may be tailored through an agreement between
the educational institution and the private health facility occurs in medicine.
One interview conducted with a key informant involved in the organisation of medical
placements indicated that undergraduate medical students often undertake placements in
specialist’s rooms.
These are generally observational, and conducted with the permission of the patient. There may
be an opportunity for students to interact with or assess the patient during these appointments.
Specialists who provide this type of supervision generally have a relationship with the university
clinical school and may undertake clinical supervision for that university within a public hospital
setting.
10.4.2 Recognition of the role of supervisors in the private health sector
Recognition for the role of a supervisor is varied in the private health sector.
Interviews and survey responses indicate that recognition for the role of a supervisor is varied in
the private health sector.
The majority of survey respondents who identified as providing supervision to students, trainees
or interns within the last 12 months indicated that the provision of supervision is a formally
recognised part of their role (Figure 10.1).
Figure 10.1: Recognition of the role of a supervisor in the private health sector (n=24)
1
4
Yes
No
Unsure
19
In contrast, interview responses indicate that provision of supervision may or may not be
included in a private health professional’s job description. Despite this, the provision of
supervision to students and trainees may be expected. This expectation to provide supervision is
also common to the public health sector.
“Usually the people that we would be recommending as supervisors for students would be a
level within the organisation where it would be part of their job description.”
“… Its’ additional… they don’t get paid for it … any Registered Nurse knows it’s part of your
scope that you need to participate in the training of others, and mentoring and preceptoring.”
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One interview with a key informant involved in the supervision of students and trainees in
nursing indicated that while supervisors do not get compensated to provide supervision, gaining
experience as a supervisor can be opportunistic for those nursing professionals wishing to move
into different nursing role, such as a nurse educator or a clinical nurse specialist.
“…it’s also very good pathway if they wanted to become a nurse educator or clinical nurse
specialist … we find we’re getting a lot of interest.”
Case example – Recognition of nursing supervisors
One private health facility described how they had put in place a number of measures to ensure
their supervisors felt valued for their contribution.
“We have monthly awards, we highly publicise it in our newsletters, students and graduates get
to nominate their preceptor, their mentor, every month for an award”
Supervisors win awards and recognition from higher management. The facility stated that
acknowledging the contribution of its supervisors in this way is important for the continued
success of their supervision programs.
10.4.3 Training for supervisors of students and trainees in the private health sector
Supervisors of students and trainees in the private sector do undertake training to
support their role as supervisors. This training is comparable in the training undertaken
by supervisors in the public sector.
Certificate IV in Workplace Training and Assessment was the most commonly completed
training undertaken by current supervisors in the private health sector.
Provision of training to supervisors in private health facilities varies by discipline, facility and
educational institution. Interviews conducted with both educational institutions and private health
facilities indicated that, typically, the onus is on the educational institution to provide supervisor
training.
“We run annual workshops of supervision skills with <another university> for supervisors
taking our students on placement externally.”
One interview conducted with a key informant from physiotherapy indicated that the educational
institution provides annual supervisor training, and in the interim takes steps to ensure any new
supervisor or site is well instructed.
“Any new site … or new supervisor is encouraged to come to our annual New Educator
Workshop. But … if that’s not going to take place before they take the student, an academic
normally goes out and visits them … if there are other supervisors there at that site already they
might do things over the phone and then arrange a mentoring situation.”
Two interviews with separate private health facilities indicated that the facility itself provides
additional supervision training to its staff. The type of training mentioned in these cases were
provided by third-party private training organisations, and funded by the private health facility.
These are explored in further detail in the case examples below.
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Case example – Action learning
One community-based health facility indicated that its senior supervisors were trained in
facilitation by a third-party registered training organisation. These facilitators convene
learning groups, made up of a mix of workers from across their organisation, to implement an
action learning scheme.
Action learning involves the groups discussing real-life situations and challenge faced at
work, and reflecting on their actions.
“… it’s just a means where staff teams can actually get together and be quite objective about
some of the challenges they face in the work, and … discuss those issues with the reflective
process. It also helps with understanding some of your own values and how that might
impact on the work that you do with students”
Often these learning groups are used as a time to reflect on a supervisors approach with a
student or trainee.
The reflection component of the action learning scheme may also be used with a student to
help them reflect on their actions and choices.
Case example – Certificate IV in Workplace training and assessment
One private hospital organisation indicated that it requires all nursing and midwifery staff
involved in the assessment of students and trainees to have completed a Certificate IV in
workplace training and assessment.
“We train our staff to have the minimum assessor skillset from the TAE* … That’s what we
want to have our assessors to be qualified in.”
The private hospital organisation pays for its staff to undertake this training, however not all
private health facilities have these same requirements.
“We’ve invested a lot of money actually to train staff … that for us is our minimum
requirement. That’s what we want to have our assessors to be qualified in. However I know
in some places they don’t need that and they’re saying they don’t have to do it, so long as
there’s somebody in the hospital that has that qualification.”
* TAE is a training and assessment program run through TAFE and other VET colleges that includes the competition
of the Certificate IV in Workplace Training and Assessment.
The majority of survey respondents who identified as providing supervision to students, trainees
or interns within the last 12 months indicated that they had received some form of training
specific to their role as supervisor.
Certificate IV in Workplace Training and Assessment was the most commonly identified training
undertaken, followed by a university degree or diploma specific to supervision (Table 10.8). It
should be noted that, although this course was nominated by the highest number of current
supervisors, it is not considered a gold standard qualification for supervision in a clinical
workplace.
159
Table 10.8: Training undertaken by supervisors of students, trainees and interns in the
private health sector (n=19)*
Training program
n
Certificate IV in workplace training and assessment
12
Other TAFE or VET college course
1
University degree or diploma in supervision
6
Training program or seminar run by a university
1
Training program or seminar run by a health facility
7
Other
†
2
*respondents could nominate more than one training course
†
Other training programs nominated were Masters in Adult Education and Graduate Certificate in Nursing
Education.
Point of comparison with the public health sector: supervisor training in nursing
Interviews conducted with 3 separate private health facilities indicated that the training
requirements for facilitators and preceptors in nursing are common to both the public and
private setting.
As is the case for the public sector, outlined in Chapter 8, facilitators of nursing students and
trainees in the private sector are required to undertake facilitator training. This facilitator
training is typically provided by the educational institution.
“for the facilitators they go to their education days that they [the university] run prior to any
clinical placement that they’re going to be doing. They get given a work book and so forth.”
Preceptor training is undertaken in-house in both the public and private setting.
‘we run a preceptor workshop which they obviously can go to if they want’
10.4.4 Overview of experience and skills for supervisors of students and trainees in the
private health sector
The experience and skills required for supervisors of students and trainees in the private
health sector are comparable in those of supervisors in the public health sector.
Clinical skills and knowledge is a core skill required of supervisors.
Remediation of underperforming students is one area in which supervisors would like
additional training.
Interviews with key informants from private health facilities and educational institutions indicated
that the experience and skills required for supervisors of students and trainees in the private
health sector are comparable in those of supervisors in the public health sector outlined in
Chapter 9.
Required experience of supervisors in the private health sector
During interviews, key informants were asked to outline the experience required by supervisors
of students and trainees in the private health sector.
The level of experience reported to be required in a supervisor varied by discipline, educational
institution and private health facility.
160
As mentioned in Section 10.3, some private health facilities indicated that educational institutions
use site visits and correspondence prior to the clinical placements to ensure the facility has
appropriately experienced staff to provide supervision.
“They usually just kind of want to be assured that we have someone of, the same profession
who might be available to the student to provide supervision … for instance if we’ve got a social
work student, then you know we need to ensure that we do have a social worker available to do
the supervision.”
The assessment of what is deemed appropriate experience appeared to vary between
disciplines and between institutions. Some educational institutions may require a supervisor to
simply be registered in the same discipline as the student. Other educational institutions may
require supervisors to have a certain number of years’ experience working in their field.
“They obviously have to be qualified Physiotherapists and not in their first two years.”
“Supervisors are required to hold a post-graduate degree in clinical psychology from a university
and to have had two years of supervised practice themselves. They submit a CV and need to
have been endorsed by the Psychology Board of Australia.”
Some private health facilities indicated that they assess the experience of their supervisors
internally, and assign students, trainees or interns to those deemed most suitable.
“We try not to give any of our new graduate nurses students because obviously it’s too hard for
the new graduate nurse to have that extra. I mean we obviously try and start with our senior
staff that are available that day and then work it down if that makes sense. It just depends on
what staff are available.”
“Usually the people that we would be recommending as supervisors for students would be a
level within the organisation where it would be part of their job description to be kind of
mentoring some of the staff members.”
Of the survey respondents who identified as providing supervision to students, trainees or
interns within the past 12 months:
• all respondents indicated they had over 5 years’ of experience working as a clinician
• the majority of respondents had between 5 and 10 years or 10 and 20 years’ of experience
providing supervision to students, trainees and interns (Figure 10.2).
161
Figure 10.2: Years of experience as a clinician and as a supervisor in the private health sector
(n=24)
12
Experience as a clinician
10
Experience as a supervisor
8
6
4
2
0
<1y
1–5 y
5–10 y
10–20 y
> 20 years
Required skills of supervisors in the private health sector
During interviews, key informants were asked to describe the skill required by supervisors of
students, trainees and interns undertaking clinical placements. Details of the identified skills are
described in Table 10.9
Table 10.9: Skills required by supervisors of students, trainees and interns identified by
interview respondents
Required skill
Detail
•
Clinical skills and knowledge acquired through years of experience are
important
•
A supervisor’s clinical experience is often taken into account by the private
health facility when assigned to a student, intern or trainee
“We want somebody who … has some clinical experience, has some
experience teaching, has a specialty in that area so obviously if you’ve got
somebody going to mental health you want someone with mental health
experience.”
Enthusiasm
•
Being open and enthusiastic to providing supervision is an important
characteristic of supervisors
“It’s the willingness to want to teach … it’s flexibility”
“We also need to look at, that they’re competent, but that they are wanting to
teach because they like taking students”
“We do look for senior staff if we can, who have got an interest in teaching.”
Remediation of
underperforming
students
•
Know how to best deal with underperforming students was a key skill identified
for supervisors
“… just learning how to have conversations that are very strength focused,
even though you might be addressing some challenging issues, it’s a definite
skill.”
Clinical knowledge
and experience
162
Required skill
Detail
Evaluation and
assessment skills
•
Knowledge of assessment and training skills are vital for supervisors
•
Some private health facilities require their supervisors to have completed a
Certificate IV in Workplace Training and Assessment, however this is not
always the case
•
The memorandum of understanding between an educational institution and a
private health facility will specify who is responsible for the assessment of a
student, trainee or intern during a clinical placement
Survey respondents were provided with a list of the core skills for a supervisor, as identified in
chapter 9, and were asked to nominate the three skills that they felt were the most important in a
supervisor. The responses to this question are displayed in Figure 10.3 below.
Clinical skills and knowledge was identified by the highest number of current supervisors as
being one of the most important core skills for supervisors. Ability to give and receive feedback
and interpersonal skills were also rated highly. These results are comparable in the findings from
the public health sector mapping study outlined in Chapter 9.
Figure 10.3: Core skills of a supervisor as nominated by supervisors in the private health sector
(n=24)*
18
17
16
14
12
12
10
8
12
9
Ability to give and receive
feedback
7
6
Adult teaching and learning
skills
6
6
4
Remediation of poorly
performing students
2
0
*respondents could nominate up to three core skills
Gaps in skills of supervisors in the private health sector
Key informants indicated that dealing with underperforming students can be difficult for health
professionals, especially those in private practice away from the additional support services
offered in a hospital setting. Interviews indicated that educational institutions often provide
guidance to supervisors to help them remediate underperforming students.
“… sometimes there can be situations where one of our academics will go out and potentially
take part in an assessment, watch what’s happening for a few hours to be able to help if there’s
a particular situation arises where a student or a supervisor is having problems.”
These findings were supported by survey responses. Respondents were asked to nominate the
core skills in which they would benefit from additional training. The responses to this question
are outlined in table 10.10 below.
163
Remediation of poorly performing students was nominated by 16 of 22 respondents as one area
in which supervisors would like additional training. This result is comparable in the findings from
the public health sector mapping study outlined in Chapter 9.
Table 10.10: Areas in which supervisors of students, trainees and interns would like
additional training (n=22)*
Core skill
n
3
9
8
4
9
16
2
*respondents could nominate up to three core skills
10.4.5 Specific skills for a supervisor in the private health sector
Critical thinking skills and balancing supervision requirements with business needs are
two skills identified as important within workplace contexts common to the private health
sector.
In addition to describing the broader skills required by supervisors, key informants were asked to
identify any skills they felt were specific to supervision in a private health setting. Key informants
found it difficult to specify skills that would be unique to the private sector, as they felt
supervisory skills were generic to all settings.
Some specific skills were identified for nursing in a private hospital and medicine or allied health
in private practice. It should be noted that these skills are in no way specific to the private
health sector. They have simply been identified through this profile as skills that are important
within specific workplace context. These workplace contexts are common in the private health
sector.
Critical thinking and actions
One interview with a key informant involved in the management of clinical nurse placements in a
private hospital indicated that the structure of private hospital wards influence the skills required
in supervisors and nursing staff in general.
The nature of services provided in a private hospital means that interns, registrars and medical
officers are not typically employed in that setting. As such, senior nursing staff on the ward need
to develop high-level critical thinking skills to be able to identify when medical intervention may
be required for a patient, and react to seek that intervention.
“I find the critical thinking skills are very important because we don’t have an intern, an SHO on
the registrar to sort out an issue if a patient gets ill. So our RN’s and EN’s really do have to be
very good at critical thinking and making those risk assessments and management at making
decisions and what to do next.”
Maintaining a high level of critical thinking, while offering guidance to students or trainees, is a
skill that has been identified as important in nursing supervisors. We acknowledge that this skill
is common to the public sector as well.
164
Balancing supervision requirements and business needs
As highlighted in interviews conducted with general practitioners during the public sector
mapping study, the supervision of students in private practice requires a specific skill set.
General practitioners and practice nurses need to be able to balance a student’s learning needs
against the requirements of the business to run effectively.
“You can decrease the burden of having a student in your practice by getting other team
members involved, having them doing other tasks apart from just sitting in the with GP … I think
there’s certainly a role for further developing what a GP placement might look like for a medical
student and then giving both tools to the GP so that they can actually start to implement it.”
This same specific skill is required by allied health supervisors in private practice.
“the additional skill is being able to balance a student’s needs against the needs of your
workplace. To be able to say how can I achieve both of these objectives … the thing you have
to work out is how you manage and balance service delivery against educational needs. That’s
a real skill to be able to put those two together.”
“I think in a private sector that is equally about how you manage your business interests and
maintaining that while at the same time as bringing students in your organisation and working
out how you’re going to help them learn so that one doesn’t become a victim of the other one.”
10.4.6 Funding for supervisors in private health facility
There is no common approach to funding private health facilities to provide supervision
to students, trainees or interns.
Interviews and background research have shown that funding is a key factor in the provision of
student and trainee supervision in the private health sector. Funding arrangements differ by
discipline, and between private health facilities and educational institutions. The details of some
funding arrangements are provided below. The impact of funding is explored in Section 10.5.
It should be noted that funding is not required to be provided to private health facilities and
supervisors. Typically a funding arrangement is developed through negotiations between the
private health facility and the educational institution. Money may come from student fees or
grants provided to the educational institution by Health Workforce Australia (HWA).
For nursing, midwifery and allied health, interviews did not reflect a consensus in the approach
to funding supervision in private health facilities.
Some educational institutions fund the supervisor position within the private health facility for the
duration of the clinical placement. This is comparable in the procedures for funding in the public
health sector.
Some educational institutions provide an allowance to private health facilities to cover the
administration costs of taking on students, trainees and interns in clinical placements.
Case example – Physiotherapy
One interview with a key informant involved in the management of clinical placements for
physiotherapy undergraduates indicated that the educational institution has an agreement with
its private health facilities to fund the administration costs associated with clinical placements.
The educational institution pays the private health facility $21 per student per week of
placement.
“It was set up with the intention of covering some of the administrative costs rather than the
actual wage of the person, for supervising.”
165
In some cases, the supervision of students, trainees and interns in a private health facility is
supported by a government grant. Supervision of undergraduate and graduate medical students
in general practice is one example of when this occurs.
The Practice Incentive Programs (PIP) Teaching Incentive encourages general practices to take
on the clinical placements of medical students and PGY1 interns under the PGPPP. The
program aims to ensure medical students and interns are appropriately trained and have actual
experience in general practice.
GPs are expected to engage in normal consultations when the student is present. Incentive
payments are made to compensate the practice for the reduced number of consultations
conducted due to the presence of the student. Payments are dependent on practice size, patient
numbers and patient variety.
10.5 CAPACITY FOR SUPERVISION IN THE PRIVAT E SECTOR
The capacity of the private health sector to provide supervision is dependent on:
• the receptiveness of the private health facilities and the health professionals within that
facility
• the capacity of both the private health facilities and the health professionals within that
facility.
This section explores the receptiveness of the private health sector to providing supervision, and
the factors that influence the capacity of both the facility and the supervisors.
10.5.1 Receptiveness of private health facilities to provide supervision to students,
All of the private health facilities interviewed during this profile indicated that they were
receptive to taking on supervision of students, trainees and interns.
All of the private health facilities interviewed during this profile indicated that they were receptive
to taking on supervision of students, trainees and interns.
Private health facilities indicated that being affiliated with a university benefits the reputation of
the facility in the wider community. This is of particular importance in the rural setting where
community networks and supporting local students is deemed vitally important.
“Well the benefits are that … you’re therefore affiliated with the university, you are supporting the
students’ learning.”
In addition, private health facilities are receptive to undertaking supervision as they view clinical
placements as an opportunity for future recruitment. As such, an effort is made to include
students and trainees as part of the team during placements.
“The private hospitals seem a little bit more welcoming because they see it as a little bit more of
recruitment … If they’ve got an issue they like to deal with that issue. They like to help … It’s
part of their strategy and also looking at their Mission Statement … they like to help people.”
166
10.5.2 Receptiveness of supervisors in the private health sector to provide supervision to
students, trainees and interns
Among those supervisors who indicated they have capacity, there is interest to take
on more supervision of students and trainees.
interns in the past 12 months, almost one-third (32%) indicated that they do have capacity to
provide more supervision, and would be interested in doing so.
The majority of interviews indicated that staff within private health facilities are receptive to
providing supervision.
“You certainly find some staff who really love having students. Other staff who are happy with it.
On the whole there’s not too many people who don’t like it.”
“Realistically they could say I don’t want to have a student if they wanted to but we don’t come
across that too often.”
10.5.3 Factors influencing the capacity of private health facilities to provide supervision
to students, trainees and interns
Capacity of private health facilities to take on supervision of students and trainees could
be enhanced by staggering the scheduling of clinical placements from different
educational institutions, and providing additional funding to train clinical supervisors.
Interviews with key informants from private health facilities and educational institutions identified
a number of factors that can affect the capacity of a private health facility to take on student,
trainee or intern supervision. These factors include:
• timing of clinical placements
• funding to support supervision
• business ‘down time’
• student preference/interest in certain placements.
These factors are explored in detail below.
Timing of clinical placements
The most critical factor influencing the capacity of private health facilities to provide supervision
to students, trainees and interns is the timing of clinical placements. This factor was highlighted
by multiple private health facilities, who indicated that they would have capacity to take on
additional clinical placements if educational institutions spaced out their placement blocks.
“They all want middle of the year and they all want end of the year.”
“In October/November we were at maximum capacity which is 30 students because it’s really
then we’ve got one staff member per student … I think the dates (are) what restricts us from
taking more students.”
“We’re busy in January because we have <university> students who are finishing towards the
end of the year but then we’re fairly quiet right up to about the beginning of May. So we have …
three months where the students don’t come out because obviously they’ve just changed their
years so … they haven’t learnt enough to come out in placement and so forth but that’s the only
time that we would be able to take more on.”
“There would be capacity if the dates could be changed”
167
Educational institutions time clinical placements to ensure the students, trainees and interns they
send out on clinical placements are adequately prepared.
“… first years in particular, you need to give them some input before you send them out and
therefore nearly all of us wanting to students out in June/July or the end of the semester.
Whereas earlier on in the semester we can send other students out but we still again end up
vying for the same sort of level of clinical experience.”
As a result, institutions are often competing for clinical placements at the same time during a
semester, and this needs to be managed by the private health facilities.
“The timing is (a barrier) I must admit … they try and share them (clinical placements) among a
number of universities … and give everybody a bit of a go.”
Educational institutions interviewed were aware that timing of clinical placements can be a factor
that affects a facility’s capacity for clinical placements. One institution indicated that they had
tried to collaborate with other institutions to manage the situation.
“I’m just not sure what you can do about that, other than what we’re already doing and trying to
collaborate with at least a couple of the other different universities.”
Case example – physiotherapy
NSW universities that run physiotherapy degrees come together to collaborate and synchronise
their clinical placement calendars to ensure there is no overlap between the universities.
“… (one) hospital might take … a student for the month of June but someone else needed it for
the last week of June and the rest of July, and as a result they couldn’t take a placement
because that will overlap.”
The universities send out a combined letter and calendar to all sites for clinical placement. This
helps the clinical placement sites to manage their intake of students, and ensures optimal
capacity for physiotherapy students.
Funding for clinical placements
The cost associated with taking on clinical placements in private facilities was identified as a
capacity-limiting factor for supervision in the private sector.
“I think one of the big things will always be cost.”
Costs associated with a clinical placement include administrative costs, payments for facilitators
(nursing and midwifery) and the potential loss of business hours that may results from having a
student on clinical placement.
Private health facilities indicated that additional funding could also be used to up-skill their
current workforce to take on clinical supervision.
“… that would also mean that we could actually target some of our workers to become clinical
supervisors.”
Business ‘down time’
As private hospitals are privately managed businesses, they often have a period of reduced
service or ‘down time’ over the Christmas or Easter period. This is because the surgeons who
work in these facilities often take leave over these periods.
As a result, the facilities generally have a smaller patient load and have less capacity to take on
students, trainees and interns for clinical placements during this time.
168
“Generally around that December/January period is when private facilities tend to actually have
a little bit of a slower time. Surgeons aren’t there so they won’t take as many students at that
time.”
“They wouldn’t take as many when the hospitals have got down time which is generally over the
Easter and the Christmas period … the publics have that down time at times as well when you
look at when they can do it. But your private very much so because the surgeons really, if
there’s no surgery happening they don’t get any patients and they close the wards.”
Student preference
As reported in Section 10.3, students may approach private health facilities to undertake a
clinical placement. One interview conducted with a community-based private health organisation
indicated that some of its facilities are more popular than others for students. Interest from
multiple students at the same time limits the capacity of these services to take on placements.
“I think it depends where the student wants to go on the placement … if they are all interested in
one area, for instance the women and children’s program, then of course we would have to
consider very carefully how many students that service could take.”
10.5.4 Factors influencing the capacity of supervisors in the private health sector
More than half of survey respondents who identified as providing supervision to
students, trainees or interns in the past 12 months indicated that they do not have
capacity to provide more supervision.
Low supervisor to student ratios was identified as a capacity limiting factor by both
current supervisors, and health professionals not currently providing supervision.
Current supervisors of students and trainees
interns in the past 12 months:
• more than half indicated that they do not have capacity to provide more supervision
• over one quarter indicate that they do have capacity and are interested in providing
supervision (Figure 10.4).
Figure 10.4: Capacity of current supervisors in the private health sector (n=22)
3
No capacity
Capacity, interested
12
7
Capacity, not interested
169
interns in the past 12 months:
•
the major factor reported to influence capacity for all disciplines was low supervisor to
student ratios (Table 10.11)
•
another high-rating factor was the difficulty finding a balance between service delivery
and teaching
•
only 1 respondent identified access to training as a capacity-limiting factor.
Table 10.11: Factors affecting capacity for current supervisors of students, trainees and interns
the private health sector (n=21)*
n
Difficulty finding a balance between service delivery and teaching
7
6
9
4
6
5
Access to training
1
Currently involved in clinical supervision of registered staff
7
0
Other
2
*People could nominate more than one factor affecting capacity.
Non-supervisors of students, trainees and interns
Of the five survey respondents who indicated that they did not provide supervision to students,
trainees and interns, four indicated that they had capacity and were interested in undertaking
supervision.
For those interested in undertaking supervision to students, trainee or interns, low staff to patient
ratios were identified as a capacity-limiting factor to providing this supervision.
Two respondents indicated that having sufficient time to allocate to supervision would help to
increase their capacity.
10.5.5 Interest in a training strategy for supervisors in the private health sector
Current supervisors in the private health sector indicated a preference for face-to-face
supervisor training, with an emphasis on case study or scenario-based learning.
A total of 13 survey respondents who identified as providing supervision to students, trainees or
interns in the past 12 months indicated that they would be interested in undertaking a training
course specific to their role as supervisors.
170
Respondents described components of an ‘ideal’ training course. These ideas are listed in Table
10.12. Where an approach was suggested by more than one respondent, this is noted in
parentheses.
10.12 Survey respondents’ suggestions for a training strategy to increase capacity for supervisors
Theme
Suggestions
Mode of delivery
• Face-to-face (6)
• Combination of online and face-to-face
• Online and webinars (3)
Content
• Case studies or role play scenarios (3)
• Specific skills for helping underperforming students (3)
• Principles of adult learning
• Overview from training institutes regarding curriculum and expectations (2)
171
10.6 FINDINGS FROM THE PROFILE OF SUPERVISORS IN THE PRIVATE HEALTH
SECTOR
10.6.1 Areas of commonality between supervisors in the private and public health sectors
This profile of supervisors of students and trainees in the private health sector identified many
commonalities with supervisors in the public health sector. These commonalities are described
below.
Supervisors of students and trainees in the private health sector approach supervision in
the same manner as supervisors in the public health sector.
The approach to supervision of students, trainee and interns does not differ between the public
and private health sectors.
Interviews indicate that supervisors and health facilities in general, are guided by the
expectations of the educational institution, the objectives of the student or trainee’s curriculum,
and the requirements of professional registration boards. These guiding elements are common
for both the public and private health sector.
As identified in the public sector mapping study, supervision is typically provided in a direct
manner to students and trainee at the point of patient care by staff employed by the private
health facility.
Supervisors of students and trainees in the private health sector have similar level of
clinical and supervisor experience as supervisors in the public health sector.
Interview and survey responses indicate that the required level of skill and experience for
supervisors in the private sector does not differ from the requirements of the public health sector.
Supervision of students or trainees in the private health sector is typically provided by more
experienced/longer serving health professionals in a facility. Interview respondents agreed that
recently graduated or registered clinicians are not called on to provide supervision.
Provision of supervision to students and trainees is an expected part of a health
professional’s role.
As identified in the public sector mapping study, the requirement to provide supervision in the
private health sector may or may not be included in a health professional’s job description.
Despite this, the provision of supervision to students or trainees is typically expected of
experienced health professionals.
Supervisors of students and trainees in the private and public health sectors identify
common skills as core to the provision of supervision.
When asked about the core skills required of supervisors, key informants in both the public and
private health sectors identified a number of common skills.
Generic supervisory skills, including clinical skills and knowledge and interpersonal skills, are
core to supervision in both health sectors.
There are some additional skills that may be required by supervisors in different contexts. These
contexts may include community-based settings or private business settings.
During this private sector profile, some additional skills identified as important to a private setting
included critical thinking skills, and balancing supervisor and business requirements. It should be
acknowledged that these skills are not specific to the private health context.
172
Supervisors of students and trainees in the private and public health sectors identify
common skills, such as remediation of underperforming students, as areas in which they
require additional training.
When asked about areas in which supervisors may require additional training, key informants
and survey respondents in both the public and private health sector identified a number of
common skills.
Remediation of underperforming students was one area identified by supervisors in both the
public and private sectors as requiring additional training.
Balancing the requirements of supervision with business/workload is a key area in which
supervisors require additional support, in both the private and public setting.
Survey respondents in both the public and private health sectors identified that finding a balance
between supervision and workload is a main factor influencing their capacity to undertake
supervision of students, trainees and interns. This factor may be a particular barrier to
supervision in private practices.
Key point for consideration
These commonalities suggest that any training strategy developed to enhance the capacity of
supervisors in the public health sector would be applicable and well-received by supervisors in
the private health sector.
While contextual differences do influence some of the skills required for supervision, these
differences are not as a result of the private/public
Implications from this mapping study of both the public and private health sectors are outlined in
Chapter 11.
10.6.2 Areas of difference for supervision in the private health sector
There are, however, some additional considerations to bear in mind when accessing additional
capacity for supervision in the private health sector.
Building and maintaining a relationship with a private health facility can be time
consuming
Private health facilities fall outside the remit of the NSW Ministry of Health, and are therefore not
included in public health procedures and programs such as Clinconnect. It can be time
consuming for educational institutions to establish and maintain a relationship with facilities
“The processes are more time consuming and labour intensive and in most cases, but not in all,
but in most cases you’re looking at doing this for a smaller number of students. So quite time
consuming.”
Educational institutions rely on private health facilities to provide specific clinical placements. As
such, taking the time to maintain the relationship is very important. However, private health
facilities can generally only offer a smaller number of placements compared with their public
counterparts. This results in a greater amount of time being taken by the educational facility to
maintain a relationship with the private health facility, for less return on investment.
“… in a lot of the private organisations there’s often not that capacity, or there’s a lot more riding
on whether or not they have capacity, so then you’ve got more relationship to maintain, but for
less, well for the same number of places.”
Some private health facilities have affiliations with specific educational institutions
It appears common for private health facilities and educational institutions to form affiliations
regarding the clinical placement of students, trainees and interns. These affiliations can be longstanding, and are outlined in a memorandum of understanding between the parties.
173
“We have agreements with <three universities> and then dependent on availability and dates we
also take students from <three additional universities>.”
“We obviously put our <three universities> students in first. That is the agreement that we’ve got
and then we see where we can put other students, fit them in around their dates and so forth.”
Affiliations are typically formed at a discipline level between the educational institution and the
private health facility. As a result of these affiliations, priority is given to provide clinical
placements to students from the affiliated institution.
There can be competition for clinical placement spots within private health facilities
Whether a private health facility has affiliations or not, there can be competition between
educational institutions for placements within a facility.
“This is a competitive world. And we’re actually trying to work with <university>. We’ve met and
looked at their placements and tried to see if we can work with them and see when they’re
sending their students and for different things. But it does come down to being quite
competitive.”
One interview suggested that educational institutions may use additional funding or payments to
a facility to gain additional placements for students, trainees or interns.
Key point for consideration
These considerations do not impact on the supervisors directly, and as such should not impact
on any training strategy developed for supervisors.
However, there may be opportunity to review these considerations and develop a strategy to
address capacity-limiting factors for the uptake of supervision within the private health sector at
a facility level.
This additional strategy may address:
• ways to effectively manage the relationship between training institutions and private health
facilities
• methods to streamline the scheduling of supervision opportunities within private health
facilities
• appropriate expectation of funding for supervision in private health facilities.
174
11. CONCLUSIONS AND IMPLICATIONS
This mapping study set out to develop a profile of supervision of students, trainees and interns
across allied health, dentistry, medicine, midwifery and nursing in the NSW public and private
health sectors. The findings from this mapping study will be used to inform approaches to
increase capacity for supervision of students, trainees and interns across both health sectors.
This will involve consideration of the findings from this study and their implications by relevant
experts in clinical supervision within the NSW public and private health sectors.
The provision of supervision does not differ between the public and private health
sectors
Findings from separate profiles developed of supervisors in the public and private health sector
show that the skills, experience and approach to supervision between these groups is
comparable.
Key implication
Strategies developed to enhance the capacity of supervisors in the public health sector would be
applicable and well-received by supervisors in the private health sector.
Supervisors were identified across all LHDs in NSW
This mapping study identified supervisors of students, trainees and interns in allied health,
dentistry, medicine, midwifery and nursing across all LHDs in NSW.
The majority of supervisors identified in both the public and private sector were aged in their 30s,
40s and 50s and had multiple years’ experience in their field. The age group of people identified
as providing supervision suggests that the student supervision workforce is, in general, unlikely
to be at immediate risk from a loss of current supervisors nearing retirement.
Supervision of students, trainees and interns, identified through the public sector mapping study,
appears to be undertaken most commonly in a hospital or ward based setting. Supervision of
students, trainees and interns in the private health sector may be undertaken in a hospital or
ward based setting, community or private practice setting.
In both sectors, direct supervision is the most common approach taken, suggesting that
supervisors work with their students, trainees or interns at the point of patient care, and are
available to direct and intervene when required.
Key implication
Strategies developed to increase capacity for supervision of students, trainees and interns
should focus on those providing direct supervision in the workplace.
Provision of supervision is context specific
Although direct supervision was identified as the most common approach to supervision of
students, trainees and interns across all disciplines, the context in which supervision is provided
appears to vary.
Requirements for supervisors and students can differ in regional and rural placements and in
Specialty Health Service settings (such as Justice and Forensic Mental Health). Community or
private practice settings may also require additional consideration of business management and
profitability prior to providing supervision.
175
Key implication
Consideration of the context in which supervision will be important when determining strategies
to increase capacity for supervision. Contextual differences may also limit comparisons of
provision of supervision across different disciplines and service settings in NSW.
The expectation that ‘everyone provides supervision’ may undervalue the supervisory
role
The culture of the NSW health workforce, both public and private, is such that provision of
supervision to students, trainees and interns is an expected part of a health professional’s role.
As such, provision of supervision for junior staff is generally written into a health professional’s
job description or an accepted part of the role. In addition, the expectation of supervision is such
that specific funding for a supervisory role is generally not provided. This has the potential to
undervalue the role of supervisors and results in less focus being given to strategies to up-skill
staff in this role.
Key implication
There is a need to change the culture of supervision such that greater value is placed on the role
of supervisors.
Other factors are important influencers of capacity for supervision
The main factor impacting on capacity for supervision by both current supervisors and noncurrent supervisors in the public and private setting is the difficulty in finding a balance between
Key implication
Up-skilling supervisors in how to provide supervision in a way that minimises impact on daily
practice may be beneficial.
There is capacity for more supervision within the public and private health workforce in
NSW
While many health professionals feel that they are at or beyond capacity with respect to student,
trainee and intern supervision, there appears to be some capacity within the public and private
health workforce for more supervision. This capacity comes both from some individuals who are
currently providing supervision, and individuals who are not currently providing supervision but
interested in doing so.
In the public health sector, additional capacity for supervision also may be achieved through
recognition of interdisciplinary supervision.
In the private health sector, additional capacity for supervision may also be achieved through
assistance in managing the relationship between educational institutions and private health
facilities. In addition, consideration of private sector business down time when scheduling
supervision may also be beneficial.
Key implication
Consideration of strategies to promote the role of supervisor to people not currently acting in this
role may be beneficial.
Consideration of strategies to address capacity-limiting factors for the uptake of supervision
within the private health sector at a facility level may be beneficial.
176
Perception of the required core skills for supervision differs between those providing
supervision and those overseeing the provision of supervision
Interview and survey respondents were asked about the core skills required in a supervisor.
While both public and private sector survey respondents across all disciplines identified clinical
skills and knowledge as the most important core skill in a supervisor, interview respondents from
the public sector identified adult learning and teaching principles, communication skills and
critical review and reflection skills as the most important core skills.
This difference may be explained by the fact that survey respondents were individuals identifying
as providing supervision to students, trainees and interns, whereas interview respondents were
generally higher-level health service employees involved in the oversight of clinical placements
or supervisors.
Key implication
The greater emphasis placed by survey respondents on clinical skills and knowledge as a core
skill for supervisors compared with direct supervisory skills (such as adult learning principles or
remediation of underperforming students) suggests that current supervisors may not recognise
the need for up-skilling in these areas.
There are gaps in required and actual supervisory skill levels
Interview participants from the public health sector identified skill gaps for supervisors in areas of
adult teaching and learning, critical review and reflection, and understanding the roles and
responsibilities of the student and the supervisor.
Survey respondents from the private health sector identified gaps for supervisors in remediation
of underperforming students.
Key implication
Feedback suggests a need to up-skill the health workforce in generic supervisory skills, such as
adult learning principles and methods of providing supervision and feedback, both at the point of
patient care, and in a critically reflective setting.
While there is interest in undertaking training in clinical supervision, training was not
identified as a major factor affecting capacity to provide supervision
The study identified a level of interest among supervisors to participate in training programs to
increase capacity to take on supervision, in both the public and private sectors.
Survey respondents in the public sector nominated a preference for informal, face-to-face
supervision programs. Survey respondents in the private health sector nominated face-to-face
and role play scenarios as important in a supervision training program.
Despite this interest, access to training was not identified as a major factor impacting on the
capacity to undertake supervision.
Key implication
While training in supervisory skills may be beneficial across the disciplines, other strategies
should be considered to improve capacity for supervision.
177
Approaches to increase capacity for student, trainee and intern supervision should not
be considered in isolation of broader issues of clinical supervision
Feedback highlighted the fact that supervision of students, trainees and interns is one
component of a continuum of supervision that continues beyond the PGY1 year.
Key implication
Strategies to increase capacity for student, trainee and intern supervision may carry more weight
if broadened to incorporate clinical supervision at the broader level.
A ‘one size fits all’ training strategy is unlikely to be effective
Survey feedback suggests there is interest among current supervisors in undertaking training in
supervision, with more interest in informal training such as LHD-based seminars than formal
training courses.
Survey and interview feedback suggests that training for supervisors of students, trainees and
interns should incorporate face-to-face components, such as seminars/workshops.
A network of support for supervisors may be useful, to enable supervisors to learn from each
other’s experiences.
Key implication
If developed, a training strategy for supervisors of students, trainees and interns should be
context-specific and incorporate face-to-face and networking components.
Increased governance and evaluation are likely to be important factors in supervision
Interview feedback suggested there appears to be little governance that formalises the skills
required for supervisors of students, trainees and interns. There also appears to be little
evaluation or monitoring of people in supervisory roles.
Key implication
Increased governance and evaluation of supervisory roles may help to highlight the importance
of supervision, provide greater impetus to up-skill supervisors and provide ongoing feedback
about areas for future development.
178
APPENDIX I: DISCIPLINES INCLUDED IN SCOPE
Discipline category
Student, trainee or intern
Allied health
Audiologist
Art therapist
Counsellor
Dietitian
Diversional therapist
Exercise physiologist
Genetic counsellor
Music therapist
Occupational therapist
Orthoptist
Orthotist/prosthetist
Physiotherapist
Play therapist
Podiatrist
Speech pathologist
Social worker
Sexual assault worker
Welfare officer
Chiropractor
Optometrist
Osteopath
Pharmacist
Psychologist
Medical radiation scientist –
diagnostic radiographer
Medical radiation scientist – nuclear
medicine
Medical radiation scientist – radiation
therapist
Allied health assistants/technicians
Dental/oral health
Hygienist (oral health)
Oral health therapist (oral health)
Therapist (oral health)
Technician (dental)
Dental assistant (dental)
Dental student (dental)
Medicine
Pre-registration (i.e. medical student)
Post-graduate year 1 (PGY1)
Midwifery
Bachelor of Midwifery
Grad. Dip. Midwifery
Nursing
Registered nurse
Enrolled nurse
Assistant in nursing
Other nurse
Other (mostly reported
with allied health)
Aboriginal health
Medical laboratory science
Paramedicine
Sonography
Page 179 of 235
APPENDIX II: NSW CSSP ADVISORY COMMITTEE MEMBERS
Committee Member
Position
Directorate
Lyn Biviano
Chair, Allied Health
Allied health
Trish Bradd
Director of Allied Health and Chair of Allied Health
Directors Network
Allied health
Deborah Burke
Nurse Educator, Mental Health
Nursing/mental health
Richard Cheney
Area Manager, Allied Health Services
Allied health
Dr Jane Conway
Conjoint Associate Professor
university
Dr Roslyn Crampton
Chair, NSW Prevocational Training Council
Medical
Amanda Culver
R/Education Program Manager
TAFE NSW/VET sector
Dr Jennifer Hardy
Senior Lecturer, Clinical Practice Co-ordinator
Margaret Martin
Nurse Manager, Leadership and Workplace
Capabilities
Dr Rebecca Nogajski
Staff Specialist - Emergency Physician
Medical
Anthony (Tony)
O'Brien
Senior Clinical Lead Research - Associate
Professor Clinical Nursing
university
Michelle Pitt
Acting Director
Rural/VET sector
Karen Patterson
Head, Practice Development Unit
Dr Tony Skapetis
Head of Emergency Dentistry
Dentistry
Megan Smith
Allied health
Dr William (Bill) Thoo
Staff Specialist Geriatric Medicine
Medical/VET/RACP
Jennifer Wannan
Manager, Training Support Unit for Aboriginal
Mothers
Rural/VET/nursing and
midwifery
Meg Wemyss
Allied Health and Nursing Educator
Allied health
Michael Hannon
Associate Director Statewide Education Policy
Christina Harlamb
Senior Policy Officer, Statewide Education Policy
Page 180 of 235
APPENDIX III: ELECTRONIC SURVEY QUESTIONS
PREAMBLE
The NSW Clinical Supervision Mapping Study: Survey of student, trainee and intern supervision is being conducted as part of the NSW Clinical Supervision
Support Project (CSSP) funded by Health Workforce Australia (HWA). The CSSP is a $28 million program funded under the National Partnership Agreement on
Hospital and Health Workforce Reform.
This survey seeks to inform the development of a profile of student, trainee and intern supervisors across allied health, dental, medicine, midwifery and nursing in
the NSW public health service. The information captured through this survey will be used to develop a strategy for training in the clinical workplace that will aim to
increase patient safety and quality of care through increased supervision support and capacity.
This survey is being disseminated across the education and training continuum, inclusive of the full range of professions – allied health, dental, medicine,
midwifery and nursing.
It is acknowledged that, across this continuum, the definition of supervisor and supervision in a clinical context vary. For example, in nursing and midwifery,
the term supervisor may refer to the role of facilitator and/or preceptor.
For the purposes of this survey:
• Students, trainees and interns refer to those individuals undertaking education and training in a clinical placement within the health sector. The term is
inclusive of:
 students currently undertaking study through a university or VET college; AND
 students who have graduated, but are required to complete a set amount of work experience (years, hours) in order to attain registration; OR
 students who have graduated and are provisionally registered (e.g. medical graduates in their PGY1 year, who are provisionally registered).
• Supervision of students, trainees and interns refers to the oversight of professional procedures and/or processes performed in the clinical workplace.
Supervision is provided for the purpose of guiding, providing feedback on, and assessing the personal, professional and educational development of
• A supervisor of students, trainees or interns is an appropriately qualified and recognised professional, who guides student, trainee or intern education and
training during clinical placements.
Page 181 of 235
INTRODUCTORY QUESTION
Survey question
Response option/type
Notes
1. In the past 12 months, have you provided supervision
for any of the following groups as part of your role?
University, VET or private college students
Trainees
Interns
YES/NO
If yes, respondents continue
on path A.
If no, respondents continue
on path B.
PATH A: STUDENT, TRAINEE AND INTERN SUPERVISORS
The following questions relate to the supervision you provide to the group(s) you identified in Question 1
Survey question
Response options/-type
Setting scope
2. Is this provision of student, trainee or intern supervision a
formally recognised part of your role?
YES/NO/UNSURE
3. Which of the following best describes how you provide
student, trainee or intern supervision?
Select from options:
Only person supervising one student/trainee/intern
Only person supervising more than one student/trainee/intern
Part of a team sharing supervision of student/trainee/intern
4. Which of the following best describes your discipline?
Select from drop down list of top line disciplines as defined in scope
5. Which of the following best describes the
settings/services in which you provide student, trainee or
intern supervision?
Select from drop down list of settings: (option to choose more than one)
Aged care
Mental health
Primary health care
Rural and remote care
Emergency
Hospital ward-based care
Other, please specify
6. When providing student, trainee or intern supervision,
what discipline do you primarily supervise?
Select from drop down list of top line disciplines as defined in scope
Page 182 of 235
Survey question
7. Which of the following best describes the students,
trainees or interns to whom you provide supervision?
Select from drop down list of student types within nominated discipline
8. Which of the following best describes your role as a
student, trainee or intern supervisor? (tick all that apply)
Tick options (can select more than one) based on types of supervision identified in HWA
framework.
e.g.
Direct supervision, present, observing students, working with and directing students, trainees or
interns
Indirect supervision, easily contactable by students, trainees or interns but not directly observing
Providing guidance, pastoral care or mentoring support
9. Approximately how many years (full-time equivalent)
experience do you have in providing supervision for
students, trainees or interns?
Enter number
10. Over the past 12 months, for the weeks in which you
provided supervision to students, trainees or interns, on
average how many hours per week did you spend doing
so?
Select from a list of ranges:
<1 – 5 hours
5 – 10 hours
10 – 15 hours
15 – 20 hours
20 – 25 hours
25 – 30 hours
30 or more hours
11. Please list the approximate number of students, trainees
or interns under your supervision in the past 12 months
and the typical duration of these placements.
Matrix containing the following clinical placement durations:
•
•
•
Long-term (1 month – 6 months)
•
Extended long-term (6 months – 12 months)
• Full-time staff member (12 months)
Respondents will be able to enter a number indicating the number of students in supervision for
each duration.
Page 183 of 235
Survey question
Response options/type
12. Which of the following best describes your capacity to
undertake student, trainee or intern supervision?
Select from the following:
•
I am currently at capacity and cannot take on any further supervision
•
I have the capacity to take on some more supervision
•
My supervision skills are underutilised, I am able to take on much more supervision
•
13. Which of the following factors influence your capacity to
take on additional student, trainee or intern supervision?
Select from a list (option to choose more than one)
14. What would help improve your capacity to take on
additional student, trainee or intern supervision?
Free text
15. What proportion of your role is funded specifically to
provide student, trainee or intern supervision?
Select from a list of ranges (e.g. None, 1–25%, 25–50%, 50–75%, 75–99%, fully funded, unsure)
16. Rank the importance of the following core skills for
student, trainee or intern supervisors from 1–7, with 1
representing what you feel is the most important skill and
7 representing the least important skill in supervision.
List of core skills for supervisors. Respondents enter 1–7 beside these options.
e.g. Clinical skills and knowledge
Other (please specify)
•
•
•
•
•
•
•
•
•
•
Supervisor to student ratios
Ease of dealings with universities, TAFE or other colleges
Access to training
Page 184 of 235
Survey question
17. Have you completed any formal training courses specific
to your role as a student, trainee or intern supervisor (tick
all that apply)?
17a. If so, how was this course delivered?
Select from drop down list:
No formal training completed
Graduate diploma
Master’s degree
Doctorate
For the course selected, select from drop down list:
Face-to-face
Distance education
Online modules
18. Have you completed any other training specific to your
role as a student, trainee or intern supervisor (tick all that
apply)?
18a. If so, how was this training provided?
Select from list (option to choose more than one):
No training completed
LHD-run course
Other – please specify
Face-to-face
Distance education
Online modules
Page 185 of 235
Survey question
19. Would you be interested in completing any of the
following formal training courses specific to your role as a
student, trainee or intern supervisor (tick all that apply)?
No current interest in training
Graduate diploma
Master’s degree
Doctorate
20. Would you be interested in attending any other training
specific to your role as a student, trainee or intern
supervisor (tick all that apply)?
LHD-run seminar/workshop
LHD-run course
External seminar/workshop
21. What is your preference for the mode of training to
support your role as student, trainee or intern
supervisor?
Attending formal training course
Seminar/workshop
Paper-based distance education
Online module
On-the-job training
22. Which of the following best describe barriers you face in
accessing additional training?
Time
Cost
Location of training programs
Limited awareness of training programs
23. Do you provide supervision for students, trainees or
interns from disciplines other than the primary discipline
you have indicated here?
YES/NO/UNSURE
23a. If yes, please list the other discipline/s for which you
provide supervision.
Free text
Page 186 of 235
Survey question
23b. Which of the following best describes this supervision of
other disciplines?
PATH B: NOT CURRENTLY A STUDENT, TRAINEE OR INTERN SUPERVISOR
Survey question
Setting scope
2. In the past, have you ever been involved in the
supervision of students, trainees or interns?
YES/NO/UNSURE
List of top line disciplines as defined in scope
1. Which of the following best describes your workplace
setting/service?
Select from drop down list of settings:
Aged care
Mental health
Primary health care
Rural and remote care
Hospital ward-based care
Emergency
Select from the following:
I do not have capacity to provide supervision
I have capacity to provide supervision and I am interested in doing so
I have capacity to provide supervision, but I am not interested in doing so
Unsure
6. If you are interested in providing student, trainee or intern
supervision but do not currently do so, what are the
reasons for this?
List HWA factors
•
•
•
•
•
•
Lack support for underperforming students
Page 187 of 235
Survey question
•
•
•
•
•
7. What would help improve your capacity to take on
supervision?
Access to training
Open ended
Training for clinical supervisors
8. Rank the importance of the following core skills for
student, trainee or intern supervisors from 1–7, with 1
representing what you feel is the most important skill and
7 representing the least important skill in clinical
supervision.
List of core skills for clinical supervisors. Respondents enter 1–7 beside these options.
e.g. Clinical skills and knowledge
9. Have you completed any formal training that would allow
you to provide student, trainee or intern supervision?
(tick all that apply)
9a. If so, how was this course delivered?
No formal training completed
Graduate diploma
Master’s degree
Doctorate
Face-to-face
Distance education
Online modules
Page 188 of 235
Survey question
10. Have you completed any other training that would allow
you to provide student, trainee or intern supervision?
(tick all that apply)
10a. If so, how was this training provided?
LHD-run course
Face-to-face
Distance education
Online modules
BOTH PATH A AND B
Profile demographic data
What is your age?
Select from age ranges:
Less than 20 years
20–29 years
30–39 years
40–49 years
50–59 years
60 years or older
What is your gender?
Male or Female
Which of the following Local Health Districts do you work in?
Drop down list of 15 options plus
‘University’ and ‘TAFE or VET College’
Which, if any, of the following Specialist Health Networks do
you work in?
Drop down list of the 3 options plus
‘none’
How many years (full-time equivalent) experience do you
have working as a clinician?
Enter number
Experience
How many hours per week do you work?
Select from a list of ranges:
Capacity
Page 189 of 235
Position
Open-ended
Do you work in a private health setting/service?
YES/NO
Page 190 of 235
APPENDIX IV: SURVEY INVITATION EMAIL TEXT
Clinical Supervision Support Program: Survey of student, trainee and intern
supervision
Dear XXXXX,
Health Education and Training Institute (HETI) is undertaking a survey of student, trainee
and intern supervision across the NSW public health system. The survey is part of the NSW
Clinical Supervision Support Project (CSSP) funded by Health Workforce Australia (HWA).
The survey will be used to develop a profile of student, trainee and intern supervisors across
allied health, dental, medicine, midwifery and nursing in the NSW public health service
across the education and training continuum.
Information captured through this survey will be used to develop a strategy for training in the
clinical workplace that will aim to increase patient safety and quality of care through
increased supervision support and capacity.
You have been identified as a key contact within your Local Health District to assist in
disseminating the survey. HETI would appreciate your help to:
complete the survey via the following link
https://www.surveymonkey.com/s/NSWCSSPsurvey
forward the survey to all colleagues within your network (regardless of whether they provide
supervision in the workplace to students, trainees and interns).
If you have any questions about this request, please do not hesitate to contact Katie Baird,
Program Coordinator – NSW Clinical Supervision Support Project, on
kbaird@ceti.nsw.gov.au.
We thank you for your help with this important project.
Yours sincerely,
<Salutation>
Page 191 of 235
APPENDIX V: GEOGRAPHIC CATEGORISATION OF LHDS
Metropolitan NSW
• Central Coast
• Illawarra Shoalhaven
• Nepean Blue Mountains
• Northern Sydney
• South Eastern Sydney
• South Western Sydney
• Sydney
• Western Sydney
Rural and Regional NSW
• Far West
• Hunter New England
• Mid North Coast
• Murrumbidgee
• Northern NSW
• Southern NSW
• Western NSW
Source: http://www.health.nsw.gov.au/services/lhn/index.asp accessed 20/04/12
Page 192 of 235
APPENDIX VI: INTERVIEW PARTICIPANTS
A total of 22 participants took part in 21 interviews. Each of the core discipline areas, LHDs
and training institute types were represented by the mix of interview participants.
Many interview participants were representative of more than one locations or contexts. The
spread of interview participants is outlined in the tables below.
Interview participants by discipline and context
Discipline
Context
Primary
care
Mental
health
Aboriginal
health
Allied health
1
2
1
Dentistry
1
Medicine
1
Midwifery
1
Nursing
2
Administration
1
Emergency
medicine
Total
Paramedicine
Other
4
1
1
1
2
5
1
3
3
8
1
Other
Total
General
practice
2
7
5
1
1
2
2
1
5
22
Interview participants by institution type and discipline
Discipline
Location
Metropolitan
LHD
Rural/ regional
LHD
Allied health
1
2
Dentistry
1
Medicine
2
Midwifery
1
Nursing
3
Administration
Total
University
TAFE
4
1
1
1
1
1
2
1
1
1
6
8
1
1
8
5
1
Other
Total
Other
2
2
2
2
4
22
Page 193 of 235
APPENDIX VII: INTERVIEW SCHEDULE
Introduction
Health Education and Training Institute (HETI) has been funded by Health Workforce Australia (HWA)
to undertake a mapping study of the current clinical supervision standards in NSW across medicine,
allied health, nursing, midwifery, and dental. The findings of this study will be used to develop and
implement a NSW-wide training strategy for clinical supervision.
The mapping study is being undertaken on behalf of HETI by ZEST Health Strategies, a healthcare
communications consultancy. The team is led by Dr Alison Evans (alison.evans@zest.com.au or
mobile 0422 281 671).
Mapping study content
The mapping study has three components:
• electronic survey of supervisors of students, trainees and interns in the clinical workplace
throughout NSW
• telephone interviews with key stakeholders
• review of relevant documentation.
Your involvement
You have been identified as a key stakeholder with respect to supervision of students, trainees and
interns in a clinical workplace in NSW.
Key interview questions are outlined overleaf. We acknowledge that it may not be possible for you to
answer all of these questions.
A member of the project team will contact you to make a time to conduct the telephone interview. We
anticipate this will require around 30 minutes and may require some follow-up correspondence via
email.
With your permission, interviews will be recorded and transcribed for analysis. Interview findings will
be reported collectively and your name will not be attached to the transcription or reporting of any
findings.
Page 194 of 235
Local Health District-specific interviews
1. Introduction
I understand that you are a <insert profession> working at <insert hospital/clinic> within the <insert LHD>.
For the purposes of this survey, I ask that you answer the following questions as an employee of your
Local Health District. If you would like to answer any questions from the perspective of a <insert
discipline>, you are welcome to do so. However, I would appreciate if you could let me know when this is
the case.
1a. Within the <insert LHD> Local Health District, for what disciplines are you able to provide
information on student, trainee or intern supervision?
1b.Within this discipline/these disciplines, do you work in any specialty areas? For example, mental
health or Aboriginal health.
2. Please can you provide an overview of how the supervision of students, trainees and interns works in
your LHD?
2a. How many students are generally supervised by one supervisor?
2b. Does the supervisor work alone with the student/s, or do the supervisors work as part of a team?
2c. What is the general duration of a student’s clinical placement? (e.g. weeks, months, full-time)
2d. Is the supervision a recognised part of the supervisors role? (i.e. in job description)
•
3. Does your LHD keep records or a database of student, trainee and intern supervisors?
3a. If yes, what sort of information and how easily is it accessed? (number, positions, experience and
training?)
4. Are you aware of policies or guidelines within your LHD that apply to student, trainee or intern
supervision? If yes, please provide details.
4a. Is the supervision of students, trainees or interns evaluated and/or monitored in any way? If yes,
please provide details.
5. What level of experience and skill do supervisors generally require in order to supervise students,
trainees or interns in the workplace?
5a. Is supervision included in your employment contract or code of professional conduct/code of
practice?
5b. Are supervisors required to meet any accreditation standards? How are these assessed?
5c. Are supervisors required to complete any training programs related to their role as student, trainee
or intern supervisors?
5d. If so, does your LHD provide funding for this training?
6. In your opinion, what are the skills that student, trainee or intern supervisors require but are generally
lacking?
6a. What are the barriers faced by your LHD in accessing or providing training to up-skill supervisors?
6b. What are the barriers faced by the supervisors in accessing this training?
7. How common is interdisciplinary supervision in your LHD?
Prompts:
•
Can you provide an example of how this happens?
•
Is this supervision recognised by the students’ professional body?
8. What training does your LHD offer to clinical supervisors?
9. What would you most like to see delivered by the training program for student, trainee and intern
supervisors?
Page 195 of 235
10. Do you have any other comments about how supervision for students/trainees/interns is planned or
organised and how this fits with broader aspects of clinical supervision that we have not discussed?
11. Is there any information, resources or website that you can provide me or direct me towards that you
feel would assist in this mapping study?
Prompt:
•
Please can you email me a copy of the type of information contained in the database/list we
discussed earlier?
Discipline-specific interviews
1. I understand that you are a <insert profession> working at <insert hospital/clinic>. For the purposes of
this survey, I ask that you answer the following questions from the perspective of a <insert profession>. If
you would like to answer any questions from the perspective of your institution of local health district, you
are welcome to do so. However, I would appreciate if you could let me know when this is the case.
1a. As a <insert profession>, do you work in any specialty areas? For example, mental health or
Aboriginal health.
2. Please can you provide an overview of how the supervision of students/trainees/interns works in your
discipline?
2b. Does the supervisor work alone with the student/s, or is the supervisor part of a team?
2d. Is student, trainee or intern supervision a recognised part of the supervisors role?
3. Does your discipline keep records/database of student, trainee or intern supervisors in your workplace?
training?)
3b. Is the supervision of students, trainees or interns usually evaluated and/or monitored?
4. Are you aware of policies that your professional accreditation body applies to student, trainee or intern
4a. What are the accreditation requirements for supervisors? How are these assessed?
4b. Is supervision included in your employment contract or code of professional conduct/code of
practice?
5. What level of experience and skills do supervisors generally require in order to supervise students,
trainees or interns from your discipline in the workplace?
5a. Are supervisors required to complete any training programs related to their role as student, trainee
6. In your opinion, what are the skills that student, trainee or intern supervisors require but are generally
lacking?
• 6a. What are the barriers faced by the supervisors in accessing training to up-skill?
7. How common is interdisciplinary supervision in your discipline?
Prompt:
• Can you provide an example of how this happens?
supervisors?
Page 196 of 235
Prompt
•
discussed earlier?
Training institution-specific interviews
1. I understand that you are a <insert profession> working at <institution> training <insert student
discipline/s>. For the purposes of this survey, I ask that you answer the following questions as a
representative of your educational institution. If you would like to answer any questions from the
perspective of a <insert discipline>, you are welcome to do so. However, I would appreciate if you could
let us know when this is the case.
1a. In your role at <insert educational institution>, for what disciplines are you able to provide
information on student, trainee or intern supervision?
1b. Within this discipline/these disciplines, do you work in any specialty areas? For example, mental
2. Please can you provide an overview of how the supervision of your students, trainees or interns works
during a clinical placement?
2b. Does the supervisor work alone with the student/s, or is the supervisor part of a team?
3. Does your institution keep records/database of student, trainee or intern supervisors at clinical
placement locations?
3a. If yes, what sort of information and how easily is it accessed?
4. Does your institution provide/fund supervisors at sites of clinical placements? If yes, please provide
details.
5. What level of experience and skills does you institution generally require in the supervisors of your
students/trainees/interns on clinical placement?
5a. What are the accreditation requirements for supervisors? How does you institution assess these?
5b. What are the areas of skill that a generally lacking in supervisors of your students/trainees/inters?
5c. Are supervisors required to complete any training programs related to their role as student, trainee
or intern supervisors? If so, are these training programs provided by your institution?
5d. Is the level of supervision/skill of the supervisor evaluated and/or monitored by your institution?
6. Does your institution recognise supervision provided by supervisors from disciplines other than that for
which the student, trainee or intern is studying? (This is called interdisciplinary supervision).
Prompts:
•
Can you provide an example when this may happen?
supervisors?
Page 197 of 235
APPENDIX VIII: REVIEW OF EXISTING SUPERVISION TRAINING PROGRAMS
Table 1: NSW-based clinical supervision courses and training programs identified through background research
Name of program
Discipline(s)
Training institution
and duration
Notes
Further information
Aims to equip those who have educational
responsibilities in the health professions,
with knowledge, skills and attitudes
relevant to undergraduate, postgraduate
and continuing education.
http://sydney.edu.au/education_socia
l_work/future_students/postgraduate/
med/health_professional_education.s
html
Designed to develop and support the
careers of trained teachers who are
teaching professionals, educational
administrators, researchers and
policymakers.
http://sydney.edu.au/courses/Gra
duate-Diploma-in-EducationalStudies-Health-ProfessionalEducation
Only available part-time over 1 or 2 years.
http://sydney.edu.au/courses/Gradua
te-Certificate-in-Educational-StudiesHealth-Professional-Education
University programs
Master of Education (Health
Professional Education)
All
University of Sydney, 1
year FTE
Graduate Diploma in
educational studies (Health
All
University of Sydney, 1
year FTE
Graduate Certificate in
educational studies (Health
All
University of Sydney, 0.5
FTE
Clinical Education
All
Charles Sturt University, 1
year (distance education)
All
University of New
England, 1 trimester FTE
Clinical Education and
Teaching
http://www.csu.edu.au/courses/postg
raduate/clinical_education/
This course provides students with the
opportunity to develop and enhance their
clinical education skills and knowledge at
a postgraduate level.
http://www.une.edu.au/courses/2012/
courses/GCCET
Page 198 of 235
Postgraduate Certificate in
Nursing Education
Nursing
Charles Sturt University, 1
year (distance education)
http://www.csu.edu.au/courses/postg
raduate/nursing_education/
Area Orientation to Mental
Health Services
Mental Health
Nursing
University of Technology
Sydney
1 day training course
Training Education and Development
Activities for Mental Health Nurses
http://www.nmh.uts.edu.au/resear
ch/units/mentalhealth/training.html
Clinical Supervision
Mental Health
Nursing
Sydney
2 day training course
Preceptorship
Mental Health
Nursing
Sydney
1 day training workshop
TAFE NSW
This course is for people who wish to
develop the skills to be able to
train and assess in the Australian
vocational education and training (VET)
sector.
TAFE and other VET college programs
Certificate IV in Training and
Assessment
All
Part of the TAE10 Training and Education
Training Package
https://www.tafensw.edu.au/howe
x/servlet/Course?pInternetFlag=Y
&Command=GetCourse&Course
No=18827
Page 199 of 235
Diploma of Vocational
Education and Training
All
TAFE NSW
This qualification specifies competencies
required to practice as
experienced practitioners delivering
training and assessment services
usually within Registered Training
Organisations (RTOs) within the
vocational education and training (VET)
sector.
x/servlet/Course?Command=Get
Course&CourseNo=10445
Training Package
Vocational Graduate
Diploma in Management
(Learning)
All
TAFE NSW
This course is for people who work in the
field of organisational learning
and capability development and who are
responsible for initiating,
designing and executing major learning
and development functions within their
organisation.
No=18833
Training Package
Vocational Graduate
Certificate in Management
(Learning)
All
TAFE NSW
This course is for people who work as
managers and leaders in organisations
where learning is used to build workforce
capability.
Training Package
Clinical Educator Training
Program
Nursing
No=18830
Box Hill Institute of TAFE,
6 hours
Page 200 of 235
Graduate certificate in
clinical supervision
Psychology
Australian Institute for
Relationship Studies
(AIRS), 1 year FTE
The Australian Clinical
Educator Preparation
Program
All
Developed by
MacphersonScienctific
This is a specialist course designed for
professional practitioners who wish to
further develop their skills and knowledge
in clinical leadership, mentoring and
supervision.
6 online modules to prepare professionals
to undertake clinical education
http://www.nsw.relationships.com.au/
en/courses/airs/he/gccs.aspx
http://www.clinicaleducation.info/
LHD/Facility based programs
All Mental
Health
Disciplines
Diversity Health
Comorbidity Service Transcultural Mental
Health Centre
Teaching on the Run
All – practice
started in
medicine
TellCentre
Teach Educate Learn
Lead (Perth based)
The program offers free clinical
supervision by senior clinicians with a
range of expertise and experience in
transcultural mental health assessment
and treatment. The program provides an
opportunity for practitioners to reflect on
skills and knowledge application and
professional identity, whilst promoting
models of best practice that reflect the
current issues and needs of our culturally
diverse communities. Supervision
sessions are held monthly in closed
groups.
Designed to enable participants to build
up confidence in applying the principles of
teaching adults in the everyday work
situation.
http://www.dhi.health.nsw.gov.au/Tra
nscultural-Mental-HealthCentre/Information-for-HealthProfessionals/WorkforceDevelopment/ClinicalSupervision/ClinicalSupervision/default.aspx
http://www.tellcentre.org/compone
nt/content/article/902/78-teachingon-the-run.html
Page 201 of 235
Table 2: National clinical supervision courses and training programs identified through background research
Name of program
Discipline(s)
and duration
Notes
Further information
University programs
Master of Health
Professional Education
All
University of Western
Australia, 1.5 year FTE
Masters of Clinical
Education
All
Flinders University, 1.5
years FTE
Masters in Health Education
– Professional Education
All
Monash University, 1.5
years FTE
Master of Health
Professional Education
All
Curtin Queensland
University, 2 years FTE
Health Professional
Education
All
Monash University, 1 year
p/t
Health Professional
Education
All
Griffith University, 0.5
year FTE
Designed to suit a range of health
professionals who seek to develop
their knowledge and skills in health
professional education
Designed to provide health
professionals with the advanced
knowledge and skills required to
deliver clinical education in health
service settings.
http://courses.handbooks.uwa.edu.au/course
s/c9/90570
http://www.flinders.edu.au/courses/postgrad/
ce/
http://www.med.monash.edu.au/cmhse/cours
es/master/index.html
Provides a multidisciplinary program
of study for health care professionals
involved in teaching. The principal
aim of the program is to respond to
the growing demands for clinical
educators and meet the ongoing
professional development needs of
clinicians.
http://www.cqu.edu.au/study/what-can-istudy/health-and-medicalsciences/postgraduate-programs/master-ofhealth-professional-education
es/grad/
The program provides clinicians and
educators with the essential skills
required to facilitate effective learning
in clinical, field or professional
practice settings in the health
disciplines
http://www148.griffith.edu.au/programscours
es/Program/OverviewAndFees?programCod
e=3221&StudentTypeFilterOption=All
Page 202 of 235
Name of program
Health Professional
Education
Advancing Clinical
Education, Level 1
Discipline(s)
All
All
and duration
University of Western
Australia, 0.5 year FTE
Notes
The course explores teaching and
learning, assessment, research
methods in health professional
education
La Trobe
University,Deakin
University, Monash
University, 3 days
Further information
http://www.meddent.uwa.edu.au/courses/pos
tgraduate/coursework/gradcert-health-profed
http://www.advancingclinicaleducation.com.a
u/
Advancing Clinical
Education, Level 2
All
La Trobe University,
Deakin University,
Monash University, 3
days
Clinical Supervision, Level 1
All
Swineburne University,
1.5/wk for 1 semester
http://courses.swinburne.edu.au/subjects/Cli
nical-Supervision-1HAW422/local#assessment
All
Victoria University, 1 year
FTE
http://tls.vu.edu.au/portal/site/qualifications/di
p_ve.aspx
All
Swineburne University,
12–18 months part time
All
La Trobe University, 1
year f/t
Practice
Practice
Graduate Diploma in
Vocational Education and
Training
Graduate
Diploma/Certificate in
Clinical Education
All
Flinders University, 6
months to 1 year FTE
http://www.advancingclinicaleducation.com.a
u/
http://courses.swinburne.edu.au/courses/Dipl
oma-of-Vocational-Education-TrainingPractice-Y21697VIC/local
http://www.latrobe.edu.au/coursefinder/local/
2009/Gra duate-Diploma-in-VocationalEducation-and- Training.4454.html
Designed to provide health
professionals with the advanced
knowledge and skills required to
deliver clinical education in health
service settings.
http://www.flinders.edu.au/courses/postgrad/
ce/
Page 203 of 235
Name of program
Discipline(s)
and duration
Health Sciences (Clinical
Education)
All
University of Queensland,
0.5 years FTE
Graduate Certificate of
Clinical Education
All
Bond University, 1 year
part time
Facilitation of Learning,
Learning Module
All
The Australian Clinical
Educator Preparation
Program
School of Human
Communication Sciences
Clinical Education
Workshop Series
All
All
Notes
Further information
http://www.uq.edu.au/education/index.html?p
age=25701&pid=7720
This program is currently under
review.
http://www.bond.edu.au/degrees-andcourses/postgraduate-degrees/list/graduatecertificate-of-clinical-education/index.htm
Deakin University, 12
weeks
http://www.deakin.edu.au/hmnbs/pdu/module
s/brochu res/facilitation-of-learning.pdf
Charles Sturt, La Trobe
and Monash Universities
with the Universities of
Tasmania and Sydney, 20
hours over 12 weeks
http://www.clinicaleducation.info/index.aspx
Monash University, 17
workshops x 3 hours each
Master/Doctor of Clinical
Physiotherapy, 2 elective
subjects
Physiotherapy
University of Melbourne, 1
semester for each subject
Fieldwork Supervision
Workshop
Occupational
Therapy
Monash University, 1 day
Precentorship Training
Nursing
Monash University, 1 day
Clinical Education
Physiotherapy,
but applicable
University of
es/educat or-workshops/index.html
Rob LoPresti, Clinical Education
Coordinator, University of Melbourne.
robertgl@unimelb.edu.au
Rob LoPresti, Clinical Education
Coordinator, University of Melbourne
Page 204 of 235
Name of program
Discipline(s)
and duration
Workshops
to other
disciplines on
request
Skills for Fieldwork
Supervision
Occupational
Therapy
Multidisciplinary
Supervision Workshop
Allied Health
Clinical Teacher Orientation
Workshop
Nursing
La Trobe University, 1 day
Field educator seminars
Social Work
Deakin University, 1 day
Melbourne,1–3 hours
Notes
Further information
robertgl@unimelb.edu.au
La Trobe University, 1 day
La Trobe University, half a
day
TAFE and other VET college programs
Practice
All
TAFE Victoria, 1 year FTE
http://ballarat.edu.au/coursefinder/display.ph
p?ID=640
Practice
All
Government Training
Victoria
http://training.gov.au/Training/Details/21697V
IC
The Delta Centre, 1 day
http://www.thedeltacentre.com.au/html/s02_a
rticle/article_view.asp?id=156&nav_cat_id=2
02&nav_top_id=88
The Delta Centre, 1 day
http://www.thedeltacentre.com.au/html/s02_a
rticle/article_view.asp?art_id=132&nav_cat_i
d=185&nav_top_id=88
Advanced Supervision
Skills Workshop
Professional Supervision
Workshop
All
All
Page 205 of 235
Name of program
Training
Discipline(s)
Psychology
and duration
The Bouverie Centre, La
Trobe University.
6 day course.
Notes
This is a six-day training course,
comprising a mixture of theory and
practice in supervision. It covers a
number of topics, including the
history of supervision, supervision
models, contracting, feedback, legal
issues and ethics, diversity, and
action methods, amongst others.
Further information
http://www.bouverie.org.au/content/clinicalsupervision-training
LHD/Facility based programs
Teaching on the Run
TellCentre
Teach Educate Learn
Lead (Perth based)
Designed to enable participants to
build up confidence in applying the
principles of teaching adults in the
everyday work situation.
http://www.tellcentre.org/component/cont
ent/article/902/78-teaching-on-therun.html
Page 206 of 235
Table 3: Clinical supervision courses and training programs identified by survey and
interview respondents*
Allied health
•
•
•
•
University-run
programs
•
•
•
•
•
•
•
•
•
TAFE or other VET run
programs
Professional college
programs
LHD/Facility based
programs
Bachelor of Education
Macquarie University workshop
Masters in Pastoral Supervision
University consortium of speech pathology programmes in
NSW - clinical education workshops
University of Newcastle – Occupational therapy
University of Newcastle – Student Practice Evaluation Form
University of Newcastle short course
University of Newcastle – Department of Rural Health
training
University of QLD – Professional Leadership and Supervision
in Social Work course
University of QLD – Supervision workshop
University of NSW Supervisors Seminar
Masters in Health Management
University of Sydney, Faculty of Health Sciences – Education
and Workshops for External Supervisors
•
Australian Association of Social Workers (AASW) training for
supervisors
•
•
Dietitians Association of Australia short course
Occupational Therapy Australia 'Foundations of Professional
Supervision' course
Pharmaceutical Society of Australia - Preceptor training
Psychology Board of Australia accredited supervision
workshops (requirement to become supervisor)
•
•
•
•
•
•
Illawarra Shoalhaven 'Essential Skills for Managers' course
Nepean Blue Mountains LHD - internal courses 'Assessment
and appraisal of Learners'
NSCCAHS 'Learning and Development' course
Nursing Research Unit Prince of Wales Hospital 'leadership
and transformational facilitation' workshops
•
Statewide Supervisor training in Qld for mental health
supervisors (2 day)
programs
•
•
•
•
•
•
•
ANZCA teacher training session
Australasian Chapter of Addiction Medicine training
Australasian College for Emergency Medicine
College of Intensive Care Medicine training of supervisors
RACP 'supervisor learning' workshops & activities
RACS Surgical Teachers Education Program
RANZCP supervisor training
LHD/Facility based
programs
•
•
Illawarra Shoalhaven supervisors program
Teaching on the Run
Other
Medicine
Page 207 of 235
•
Emergency Management for Severe Trauma Instructors
course
University-run
programs
•
Bachelor of Training and Development (University of New
England)
programs
•
RACP seminars
•
•
•
Clinical leadership program
Northern Sydney Area workshops in 'assessment, leadership
and education'
Western Sydney hospital based training
•
UK Teaching and Assessing in Clinical Practice
•
•
•
Masters Advanced Clinical Studies
Masters of Education
Southern Cross University course
•
•
Advance Diploma Counselling
Certificate IV Frontline Management
•
College of Nursing program
•
•
•
Hunter New England program
Justice Health training program
SSWAHS course
•
•
•
Family Planning NSW clinical supervisor training
NSW Ministry of Health - clinical supervision short course
Clinical Excellence Commission leadership program
Other
Midwifery
LHD/Facility based
programs
Other
Nursing
University-run
programs
TAFE or other VET run
programs
programs
LHD/Facility based
programs
Other
*No specific training courses were mentioned for dentistry
Page 208 of 235
APPENDIX XI: POLICIES AND ACCREDITATION OF SUPERVISORS
The document search strategy identified very few accreditation standards and policies that outline detailed qualifications and requirements a
supervisor must meet in order to be a student supervisor or details of the supervisory role. Existing policies have a greater emphasis on student
requirements (e.g. a student must receive x hours supervision) and/or clinical supervision of existing staff and post-graduate/registration students.
Table 1 outlines all identified documents and websites that include some reference to student supervision, requirements to become a student
supervisor and/or requirements of the supervisory role.
Table 1: Identified resources including some reference to requirements for and of supervisors of students
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to
be a student
supervisor
All staff
Recruitment and
Selection of Staff of
the NSW Health
Service PD2011_032
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2011/pdf/PD
2011_032.pdf
2011
Policy
directive
Staff recruitment process
to ensure organisation can
provide necessary
supervision required of
registration status
staff/
students
no specific
requirements
All staff
Employment
Screening Policy
PD2008_029
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2008/pdf/PD
2008_029.pdf
2008
Policy
directive
Students doing work
experience for secondary
qualification must be
supervised at all times
Students
no specific
requirements
Aboriginal
family health
workers/
mental
health
Aboriginal Mental
Health and Well
Being Policy 20062010 PD2007_059
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2007/pdf/PD
2007_059.pdf
2007
Policy
directive
The Far West Aboriginal
Mental Health Workforce
Development Program
coordinates work and
study, with a system of
peer support, supervision
and mentoring.
students
no specific
requirements
Allied health
- art therapy
Australian and New
Zealand Art Therapy
Association website
ANZATA
National
http://www.anzata.
org/
2012
website
Minimum requirements for
membership include 750
supervised clinical hours
placement in the mental
health arena.
students
no specific
requirements
HETI NSW Clinical Supervision Support Project Report Final draft
Page 209 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Allied health
- audiology
2012 ASA Clinical
Internship:
information for
interns, supervisors
and employers
Audiological
Society of
Australia
National
http://www.audiolo
gy.asn.au/
2012
web info
ASA requirements for
clinical supervision of
clinical interns.
clinical
interns
(graduated
but precertification)
Includes criteria for
supervisors, roles of
supervisors,
characteristics of
great supervisors
Allied health
occupational
therapy
Occupational therapy
Australia website
Occupational
therapy
Australia
National
http://www.otaus.c
om.au/work-orstudy/what-isclinical-fieldwork
web info
Information about student
clinical placements - but
not about standards
and/or standards for
supervisors. There are
state-based
collaboratives regarding
student supervision/
clinical placements in VIC
and QLD but not in NSW
students
no specific
requirements
Allied health
- sexual
assault
officer &
welfare
officer
Australian Community
Workers Association
website
National
http://www.acwa.o
rg.au
website
includes basic
requirements of student
field work placements;
quality field placement
supervision by suitably
qualified and experienced
community sector staff
students
no specific
requirements
Allied health
- psychology
Australian
Psychological Society
Ethical Guidelines
:Guidelines on
Supervision, July
2003
Australian
Psychological
Society
National
Guidelines
available to members
only
staff and
students
details not available
to non-members;
interviews identified
that guidelines and
accreditation apply to
student supervisors
Allied health
- speech
pathology
Speech Pathology
Australia Code of
Ethics
Speech
Pathology
Australia
National
Code of
ethics
Code 3.3.6 Development
of our Profession states
“We contribute to the
knowledge and expertise
of our profession by: ...
• participating in the
clinical education and
supervision of university
and work experience
students
Staff and
students
no specific
requirements; note
policies and
procedures only
accessibly by
members
2003
http://www.speech
pathologyaustralia
.org.au
Page 210 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Dental
Oral Health Specialist
Referral Protocols
PD2011_071
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2011/pdf/PD
2011_071.pdf
2011
Policy
directive
Post-graduate trainees,
students, registrars, or
general dentists/
therapists/ hygienists
may provide some or all
of the treatment as
appropriate under
supervision of a
specialist.
students
no specific
requirements
Medicine
Pre-Internships In
Medical School
AMA
NSW
http://ama.com.au
/node/2713
2007
position
statement
AMA statement regarding
recommendations for
pre-internship medical
placements. Reference to
supervision but no
specifications re skills of
supervisor
students
no specific
requirements
Medicine GP
vocational
trainees
Visiting Medical
Officer Appointments
for General
Practitioner
Vocational Trainees
PD2011_074
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2011/pdf/PD
2011_074.pdf
2011
Policy
directive
Local Health Districts are
required to comply with
the provisions of this
Policy Directive with
respect to the
appointment, supervision
and payment of GP
vocational trainees.
students and
staff
no specific
requirements
Medicine PGY1 & 2
Clinical Training
Grants for
Postgraduate Year
One and Two Medical
Officers
PD2005_259
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/PD/2005/pdf/PD
2005_259.pdf
2005
Policy
directive
Directive regarding
funding of education,
training and supervision
of PG Y 1&2.
students
no specific
requirements
Medicine PGY1 and
PGY2
Postgraduate Medical
Council of NSW Role and
Responsibility
PD2005_143
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/PD/2005/pdf/PD
2005_143.pdf
2005
Policy
directive
Role of Postgraduate
Medical Council of NSW includes responsibility for
supervision of PGY1 and
PGY2 medical
trainees/students
students
accreditation
standards of
supervising services
rather than individual
supervisors
Page 211 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Medicine
PGY1 &
PGY2
Standards for the
Supervision of
Prevocational Doctors
in General Practice
RACGP
National
http://www.racgp.
org.au/Content/Na
vigationMenu/edu
cationandtraining/
Prevocational/Sup
ervisionStandards
/200801supervisio
n_of_prevocationa
l_doctors.pdf
2007
Guidelines
Standards for
supervisors, education of
doctors, support &
workload of prevoc
doctors, the gp facility
students
no specific
requirements
Medicine
students (pre
intern)
Guidelines for the
Supervision of
Medical Students in
General Practice
RACGP
National
http://www.racgp.
org.au/Content/Na
vigationMenu/edu
cationandtraining/
Prevocational/Sup
ervisionStandards
/200801supervisio
n_of_medical_stu
dents.pdf
2007
Guidelines
Overview of supervisory
role and attributes &
minimum qualifications
required by supervisors.
Includes
guidelines/requirements
for the general practice
facility supporting
students
students
attributes &
requirements outlined
Medical,
nursing,
paramedic
Medication Handling
in NSW Public
Hospitals
PD2007_077
NSW Health
NSW
http://www.health.
nsw.gov.au/policie
s/pd/2007/pdf/PD
2007_077.pdf
2007
Policy
directive
administration of IV drugs
allowed by following
students under following
supervision: medical
students (only under
direct supervision of
medical officer); nursing
students (only under
direct supervision of RN);
ambulance officers in
training, only under the
direct supervision of a
qualified ambulance
officer, a prescriber or a
registered nurse
students
no specific
requirements
Page 212 of 235
Discipline
Title
Organisation
Medicine
2011 Australasia
Junior Medical Officer
Forum (AJMOF)
Resolutions (From
AJMOC Committee)
Confederation
of
Postgraduate
Medical
Education
Councils
Medical,
nursing,
allied health
Student Training and
Rights of Patients
PD2005_548
NSW Health
Medicine
High-Risk Medicines
Management,
PD2012_003
NSW Ministry
of Health
Nursing
Insurance of Nurses
Undertaking Courses
Funded by or
Conducted on behalf
of NSW Health
Department
PD2005_090
NSW Health
Play Therapy
Play Therapy
Australasia (links with
Play Therapy
International
State or
National
NSW
NSW
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
http://www.pmct.o
rg.au/images/stori
es/JMO_Forum_U
ploads/Australasia
n_JMO_Forum_2
011_Resolutions.
pdf
2011
Report
This report outlines the
resolutions at the 2011
AJMOF Forum. The
meeting was attended by
more than 70 Junior
Doctors
students
Seven resolutions
regarding
requirements for
http://www.health.
nsw.gov.au/policie
s/pd/2005/pdf/PD
2005_548.pdf
2005
Policy
directive
local policies must
encompass principles
that include: Adequate
supervision of students
must be provided to
ensure an adequate
standard of patient care.
students
no specific
requirements
2012
Policy
directive
Clinical supervision is
provided through the
significant leadership and
legally defined role of the
Attending Medical Officer
(AMO) leading a team
staff &
students
no specific
requirements
2005
Policy
directive
Public Liability (including
professional indemnity)
coverage of Public Sector
Employees provides
coverage which includes
the actions of students
under supervision
students
no specific
requirements
website
approaches to
supervision depend on
the model of play therapy
approach.
students
Specifies some Play
Therapy International
standards regarding
supervision while
training - re number
of hours required, no
mention of
requirement of
supervisors
http://www.health.
nsw.gov.au/policie
s/PD/2005/pdf/PD
2005_090.pdf
http://www.playthe
rapy.org.au
Page 213 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Nursing &
midwifery ATSI
Congress of
Aboriginal and Torres
Strait Islander Nurses
website
CATSIN
national
http://www.indigin
et.com.au/catsin/i
mages/Mentoring
_Program.pdf
acces
sed
30/03
/2012
web info
CATSIN runs a mentor
program to support
student nurses from
Aboriginal & Torres Strait
Islander backgrounds
students
no specific
requirements
Nursing
National Competency
Standards for the
Registered Nurse
Nursing and
Midwifery
Board of
Australia
National
http://www.nursing
midwiferyboard.go
v.au/CodesGuidelinesStatements/Codes
Guidelines.aspx#c
ompetencystandar
ds
2006
Competency
standards
Competency 4.3 outlines
practices for Contributing
to the professional
development of others.
• demonstrates an
increasing responsibility
to share knowledge with
colleagues
•facilitates mutual sharing
of knowledge and
experience with
colleagues relating to
individual/ group/unit
problems
•acts as a role model to
other members of the
health care team
•participates where
possible in preceptorship,
coaching and mentoring
to assist and develop
colleagues
•contributes to formal and
informal professional
development
Staff &
students
4.3 includes (specific
to students):
•supports health care
students to meet their
learning objectives in
cooperation with
health care team
•contributes to
orientation and
ongoing education
programs
appropriate in
teaching others
including students of
nursing and other
health disciplines,
and inexperienced
nurses
Page 214 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Midwifery
National Competency
Standards for the
Midwife
Australian
College of
Midwives
National
http://www.midwiv
es.org.au/scripts/c
giip.exe/WService
=MIDW/ccms.r?p
ageid=10038
2006
Competency
standards
Element 2.4 Delegates,
when necessary,
activities
matching abilities and
scope of practice
and provides appropriate
supervision:
● Underpins delegation
and supervision with
knowledge of legal
requirements and
organisational policies.
● Is accountable for
actions in relation to the
decision to educate,
delegate and supervise
other health care
workers.
● Uses a range of
supportive strategies
when
supervising aspects of
care delegated to others.
● Ensures delegation
does not compromise
safety.
Students
and staff
Element 13.2
Contributes to, and
evaluates, the
learning
experiences and
professional
development of
others:
● Supports students
to meet their learning
needs and objectives.
● Contributes to
orientation and
ongoing education
programs.
● Contributes to
mentoring, peer
support and/or
clinical supervision.
Page 215 of 235
Discipline
Title
Organisation
State or
National
Link
Sonography
Clinical training for
sonographers
Australian
Sonographers
Association
National
http://www.a-sa.com.au/cms/?c=
97&clinicaltraining
Date
Category
Description
Supervisi
on
recipients
Requirements to be
a student
supervisor
website
Most students require up to
2,200 hours training in
clinical settings. ASA has
submitted funding proposal
to DoHA to:
•identify essential elements
of clinical training
requirements
•develop guidelines,
methods and example
resources for use in all
clinical training settings
•develop clinical training
supervisor face-to-face and
online training.
Students
no specific
requirements
Page 216 of 235
Table 2 outlines all identified documents and websites that include some reference to clinical supervision, requirements to become a clinical
supervisor and/or requirements of the supervisory role for supervisors of post-registration staff or post-graduate students. Note that policies
referring to supervision of students and staff appear in both Table 11.1 and 11.2.
Table 2. Identified resources including some reference to requirements for and of supervisors of post-registration/ post-graduate staff and students
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
Aboriginal
family
health
workers
Aboriginal Family
Health Workers Operational Guidelines
GL2009_001
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/gl/200
9/pdf/GL2009_
001.pdf
2009
Policy
directive
Regular, mandatory
supervision requirements
of Aboriginal Family Health
Workers (not students)
staff
no specific
requirements
All staff
Recruitment and
Selection of Staff of the
NSW Health Service
PD2011_032
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/201
1/pdf/PD2011_
032.pdf
2011
Policy
directive
Staff recruitment process
to ensure organisation can
provide necessary
supervision required of
registration status
staff/
students
no specific
requirements
All staff
Sexual Assault
Services Policy and
Procedure Manual
(Adult) PD2005_607
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/200
5/pdf/PD2005_
607.pdf
2005
Policy
directive
Includes requirements of
clinical supervision of all
staff working in counselling
services re sexual assault
(not students)
Staff
no specific
requirements
All staff
Violence Prevention &
Management Training
Framework for the
NSW Public Health
System PD2012_008
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/201
2/pdf/PD2012_
008.pdf
2012
Policy
directive
Legal obligation of all
organisations to ensure all
staff receive sufficient
training, instruction and
supervision to enable them
to work safely.
Staff
no specific
requirements
Allied
health
(post
registration
)
Providing training for
allied health clinical
supervisors discussion paper
Office of the
Allied Health
Advisor
ACT Health
ACT
http://www.hea
lth.act.gov.au/
c/health?a=se
ndfile&ft=p&fid
=436178619&si
d=
2008
Discussion
paper
Outlines the project of
providing training for allied
health clinical supervisors.
Staff
no specific
requirements
Page 217 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
Allied
health (in
rural areas)
A Report: Clinical
Supervision for Allied
Health Professionals in
Rural NSW
NSW Institute
of Rural
Clinical
Services and
Teaching
National
http://www.rur
alceti.health.ns
w.gov.au/__da
ta/assets/pdf_f
ile/0004/67936
/Rural_NSW_
Allied_Health_
Clinical_Super
vision_Paper_
Final.pdf
2008
Report
Development of a model of
formal Clinical Supervision
to support Allied Health
Professionals in rural and
remote practice in NSW.
2008 Audit found: No NSW
AHS policy detailed Clinical
Supervision training
requirements for
supervisors, and no
identifiable training
programs.
staff
no specific
requirements
Allied
health physiothera
py
Physiotherapy Board of
Australia website
National
http://www.phy
siotherapyboar
d.gov.au/
Guidelines
Guidelines for supervisors
including flowchart.
staff
Guidelines for
supervisor roles &
responsibilities but
not accreditation/
requirements to
become supervisor
Allied
health physiothera
py
Australian
Physiotherapy
Association website
National
http://physioth
erapy.asn.au/p
olicy-andcommunicatio
ns/submission
s
website
Includes a submission to
physiotherapy board draft
supervision guidelines
staff
No specific
requirements
Allied
health psychology
Australian
Psychological Society
Ethical Guidelines
:Guidelines on
Supervision, July 2003
Guidelines
available to members only
staff and
students
Details not available
to non-members;
interviews identified
that guidelines and
accreditation apply to
student supervisors
Australian
Psychological
Society
National
2003
Page 218 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
Allied
health speech
pathology
Speech Pathology
Australia Code of
Ethics
Speech
Pathology
Australia
National
http://www.spe
echpathologya
ustralia.org.au
2010
Code of
ethics
Code 3.3.6 Development of
our Profession states
“We contribute to the
knowledge and expertise of
our profession by: ...
• providing opportunities for
and supporting colleagues
to develop their
professional identity,
integrity and ethical
practice.
There is a mentoring
program for registered
practitioners
Staff and
students
no specific
requirements; note
policies and
procedures only
accessibly by
members
Clinical
staff in
Drug and
Alcohol
services
Drug and Alcohol
Guidelines
NSW
Department of
Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/gl/200
6/pdf/GL2006_
009.pdf
2006
Guidelines
Includes list of codes of
conduct for clinical
supervisors in mental
health area.
Note review due Dec 2011
staff
States clinical
supervisors need to
be aware of ethical
guidelines/ codes of
conduct relevant for
the staff they're
supervising & lists
institutions providing
the resources
Dental
Practice Oversight of
Dental Therapists,
Dental Hygienists &
Oral Health Therapists
in NSW PD2008_048
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/200
8/pdf/PD2008_
048.pdf
2008
Policy
directive
Practice Oversight
Guidelines for Dental
Therapists, Dental
Hygienists and Oral Health
Therapists- a condition of
practice and employment
staff
No specific
requirements
Medicine
Emergency Surgery
Guidelines
GL2009_009
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/gl/200
9/pdf/GL2009_
009.pdf
2009
Guidelines
Guidelines provide the
principles to be applied to
emergency surgery reform.
Includes reference to
increased trainee
supervision in emergency
surgery
staff
no specific
requirements
Page 219 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
Allied
health social work
Practice standards for
social workers:
supervision
Australian
Association of
Social
Workers
(AASW)
National
http://www.aas
w.asn.au/docu
ment/item/18
2000
standards
Sets out standards for
organisations and
supervisors, with
accompanying rationale
and operationalisation for
each.
staff
Sets minimum
standards of
supervisions for
different levels of
experience of
supervisee and
requirements for
supervisors
Medicine GP
vocational
trainees
Visiting Medical Officer
Appointments for
General Practitioner
Vocational Trainees
PD2011_074
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/201
1/pdf/PD2011_
074.pdf
2011
Policy
directive
Local Health Districts are
required to comply with the
provisions of this Policy
Directive with respect to
the appointment,
supervision and payment
of GP vocational trainees.
students and
staff
No specific
requirements
Medicine
(overseas)
International Medical
Graduates - Overseas
Funded PD2009_011
NSW Health
NSW
2009
Policy
directive
The host must ensure
appropriate supervision
when IMG on duty.
Includes regular
performance reviews and
active management of any
identified issues.
Supervisors are required to
report significant conduct,
performance or
competence issues in line
with NSW Medical Board
requirements and manage
in accordance with relevant
NSW Health policies
staff
No specific
requirements
Medicine
(VMO)
Visiting Medical Officer
(VMO) Performance
Review Arrangements
PD2011_010
NSW Health
NSW
2011
Policy
directive
VMO performance review:
Where applicable and
possible, the reviewers
should obtain aggregated
data on feedback from
medical students and junior
medical staff concerning
the teaching and
staff
No specific
requirements
http://www.hea
lth.nsw.gov.au/
policies/pd/201
1/pdf/PD2011_
010.pdf
Page 220 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
supervision provided by the
VMO, to inform them about
the issues to be covered
under Section 3 “Teaching”
in the Level 2 performance
review form.
Medicine physician
trainees
(post
PGY1)
RACP Supervisor
Support website
RACP
National
http://www.rac
p.edu.au/page/
educationalandprofessionaldevelopment/s
upervisorsupport
acces
sed
30/03
/2012
web
resources
Skills support &
requirements for
supervisors of basic
physician and advance
trainees
staff
Requirements for
supervisors of
advanced trainees
Medicine &
nursing
Central Venous Access
Device Insertion and
Post Insertion Care
PD2011_060
NSW Health
NSW
http://www.hea
lth.nsw.gov.au/
policies/pd/201
1/pdf/PD2011_
060.pdf
2011
Policy
directive
CVAD insertion should only
happen by trained clinicans
or untrained clinicians
under supervision by
trained/ experienced
clinician
staff
No specific
requirements
Medical
laboratory
science
Australian Institute of
Medical Science
National
http://www.aim
s.org.au
website
No information about
clinical placements and/or
supervision for prevocational/registration
students .
staff
limited information
about supervision/
mentorship for postgrad students
Medicine
High-Risk Medicines
Management,
PD2012_003
NSW Ministry
of Health
NSW
2012
Policy
directive
Clinical supervision is
provided through the
significant leadership and
legally defined role of the
Attending Medical Officer
(AMO) leading a team
staff &
students
no specific
requirements
Mental
health staff
Improving mental
health outcomes for
parents and infants
SAFE START
guidelines
NSW Health
NSW
2010
Guidelines
Includes rationale and
some requirements for
clinical supervision of
STAFF working with
families
staff
no specific
requirements
http://www.hea
lth.nsw.gov.au/
policies/gl/201
0/pdf/GL2010_
004.pdf
Page 221 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements of
supervisors
Nursing
National Competency
Standards for the
Registered Nurse
Nursing and
Midwifery
Board of
Australia
National
http://www.nur
singmidwiferyb
oard.gov.au/C
odesGuidelinesStatements/Co
desGuidelines.asp
x#competency
standards
2006
Competency
standards
Staff &
students
4.3 includes (specific
to students):
•supports health care
students to meet their
learning objectives in
cooperation with
health care team
•contributes to
orientation and
ongoing education
programs
appropriate in
teaching others
including students of
nursing and other
health disciplines,
and inexperienced
nurses
Nursing &
midwifery
National Competency
Standards for the
Nurse Practitioner
Nursing and
Midwifery
Board of
Australia
national
http://www.nur
singmidwiferyb
oard.gov.au/C
odesGuidelinesStatements/Co
desGuidelines.asp
x#competency
standards
Competency 4.3 outlines
practices for Contributing
to the professional
development of others.
• demonstrates an
increasing responsibility to
share knowledge with
colleagues
•facilitates mutual sharing
of knowledge and
experience with colleagues
relating to individual/
group/unit problems
•acts as a role model to
health care team
possible in preceptorship,
coaching and mentoring to
assist and develop
colleagues
•contributes to formal and
informal professional
•development
Standards build on
Competency Standards for
the Registered Nurse
Staff
Competency 3.1
Engages in and leads
clinical collaboration
that optimise
outcomes for
patients/ clients/
communities;
includes performance
indicator of
● Monitors their own
practice as well as
participating in intraand inter-disciplinary
peer supervision and
review
Competency
standards
Page 222 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Nursing &
midwifery
Australian Nursing
Federation website
ANF
National
http://www.anf.
org.au/html/pu
blications_poli
cies.html
acces
sed
30/03
/2012
web position
statements
Range of position
statements, policies and
guidelines that touch on
supervision requirements.
staff
no specific
requirements
Nursing &
midwifery mental
health
Australian College of
Mental Health Nurses
position statement
ACMHN
national
http://www.ac
mhn.org/caree
rresources/clini
calsupervision.ht
ml
acces
sed
30/03
/2012
position
statement
position statement re
supervisors
staff
Includes:
•Supervisors access
appropriate bona fide
educational
preparation for this
role and, whether
Clinical Supervision is
delivered in dyads or
within groups.
Midwifery
National Competency
Standards for the
Midwife
Australian
College of
Midwives
National
http://www.mid
wives.org.au/s
cripts/cgiip.exe
/WService=MI
DW/ccms.r?pa
geid=10038
2006
Competency
standards
Element 2.4 Delegates,
when necessary, activities
matching abilities and
scope of practice
and provides appropriate
supervision:
● Underpins delegation
and supervision with
knowledge of legal
requirements and
organisational policies.
● Is accountable for
actions in relation to the
decision to educate,
delegate and supervise
other health care workers.
● Uses a range of
supportive strategies when
supervising aspects of care
delegated to others.
● Ensures delegation does
not compromise safety.
Students
and staff
Element 13.2
Contributes to, and
evaluates, the
learning
experiences and
professional
development of
others:
● Supports students
to meet their learning
needs and objectives.
● Contributes to
orientation and
ongoing education
programs.
● Contributes to
mentoring, peer
support and/or
clinical supervision.
Page 223 of 235
Discipline
Title
Organisation
State or
National
Link
Date
Category
Description
Supervision
recipients
Requirements to be
a student
supervisor
Pharmacy
National Competency
Standards Framework
for Pharmacists in
Australia
Pharmaceutica
l Society of
Australia
National
http://www.psa
.org.au/downlo
ad/standards/c
ompetencystandardscomplete.pdf
2010
core
competencie
s
Core competency
standards touch on
supervision of staff and
students.
For staff:
Standard 3.1 Provide
leadership and
organisational planning;
Element 1 Provide
leadership includes:
2 Serves as an effective
role model and mentor
for colleagues.
4 Contributes to the
learning and professional
development of colleagues:
Staff and
students
For students:
Standard 3.2 Manage
and develop
personnel; Element 3
Develop professional
capabilities includes:
6 Seeks opportunities
to contribute to the
ongoing development
of the profession:
• Ability to provide
effective preceptor
support to interns.
The Competency
Psychology
Fact sheet for
supervisors
Psychology
Board of
Australia
National
Hardcopy
Jan
2012
Fact sheet
Overview of those roles
approved to provide
supervision in psychology
staff
Guidelines for the
registration
requirements of
supervisors
Psychology
Exposure draft:
Guidelines for
supervisors and
supervisor training
providers
Psychology
Board of
Australia
National
Hardcopy
Nov
2011
Guidelines
Guidelines to identify
psychologists who are
qualified and skilled to
provide supervision
staff
Speech
pathology
COMPASS:
Competency
assessment of speech
pathology
Speech
Pathology
Australia
National
Hardcopy
May
2012
Competenci
es
Overview of speech
pathologist competencies
staff
Page 224 of 235
Table 3 lists professional association websites that were reviewed and found to not contain relevant information about supervision, such as
accreditation standards or policies outlining requirements for supervisors or details of the supervisory role.
Table 3. Professional associations with no student supervision information on their public website
Discipline
Organisation
Website
Comments
Allied health - counselling
Australian Counselling Association
http://www.theaca.net.au/
has a 'coming soon' section
about supervision
Allied health - dietitians
Dietitians Association of Australian
http://daa.asn.au/
Allied health - diversional therapy
Diversional Therapy Australia
http://www.diversionaltherapy.org.au/
Allied health - exercise physiologist
Exercise and Sports Science Australia
http://www.essa.org.au
Allied health - genetic counselors
National Society of Genetic Counsellors
http://www.nsgc.org/
Allied health - music therapists
Australian Music Therapy Association
http://www.austmta.org.au/
Allied health - optometry
Optometrists Association Australia
Allied health - orthoptics
Orthoptics Australia website
http://www.orthoptics.org.au/OAA07/
Allied health - Orthotist/ Prosthetist
The Australian Orthotic Prosthetic Association Inc.
http://www.aopa.org.au/
Allied health - podiatry
Australasian Podiatry Council website
http://www.apodc.com.au/
Allied health -chiropractic
Chiropractors Association of Australia
http://chiropractors.asn.au
Nursing - sexual health
Australian Sexual Health Nurses Association
http://www.ashhna.org.au/
Paramedicine
Ambulance Service of NSW
http://www.ambulance.nsw.gov.au/
Page 225 of 235
APPENDIX X: PRIVATE SECTOR PROFILE INTERVIEW SCHEDULE
Introduction
The Health Education & Training Institute (HETI) has been funded by Health Workforce Australia
(HWA) to undertake a mapping study of the current clinical supervision standards in NSW across
medicine, allied health, nursing & midwifery, and dental. The findings of this study will be used to
develop and implement a NSW-wide strategy to increase capacity for clinical supervision.
The mapping study is being undertaken on behalf of HETI by ZEST Health Strategies, a healthcare
communications consultancy. The team is led by Dr Alison Evans (alison.evans@zest.com.au or
mobile 0422 281671).
Your involvement
You have been identified as a key stakeholder with respect to supervision of students, trainees and
interns in a clinical workplace in NSW.
Key interview questions are outlined overleaf. We acknowledge that it may not be possible for you to
answer all of these questions.
A member of the project team will contact you to make a time to conduct the telephone interview. We
anticipate this will require around 30 minutes and may require some follow-up correspondence via
email.
With your permission, interviews will be recorded and transcribed for analysis. Interview findings will
be reported collectively and your name will not be attached to the transcription or reporting of any
findings.
HETI NSW CSSP – Private sector interviews
Page 226 of 235
Site-specific interviews
Introduction
1. I understand that you are a <insert profession> working at <insert private hospital/clinic>. The aim of
this mapping study is to determine how supervision is organised within the private health sector. As such, I
ask that you answer these questions from the perspective of your private facility.
If you would like to answer any questions from the perspective of a <insert discipline>, you are welcome to
do so. However, I would appreciate if you could let me know when this is the case.
1a. Within the <private hospital/clinic>, for what disciplines are you able to provide information on
student, trainee or intern supervision?
Relationship with training institution
2. Can you provide an overview of how the clinical placement of students, trainees and interns is arranged
by the educational institute and your facility?
2a. Does the training institute provide or fund a supervisor/facilitator position within your facility?
2b. Does the training institute provide guidance or training on how to supervise their students, trainees
or interns?
Supervision in the clinical workplace
3. Can you provide an overview of how the supervision of students, trainees and interns is conducted
within your facility?
3c. What is the general duration of a student’s clinical placement? (e.g. weeks, months, full time)
3d. Is the supervision a recognised part of the supervisors role? (i.e. in job description)
Capacity/barriers for supervision
4. How would you describe the capacity of your facility/discipline with respect to student, trainee or intern
supervision?
Prompts:
4a. What are some of the factors affecting the capacity of your facility/discipline to provide supervision?
4b. What would help your discipline/facility increase the number of students/ trainees /interns being
supervised
Supervisor skill and experience
5. What level of experience and skill do supervisors generally require in order to supervise students,
trainees or interns in the workplace?
5a. Are there any skills and experience that are particularly important for supervisors within the private
health context?
5b. Is supervision included in your employment contract or code of professional conduct/code of
practice?
5c. Are supervisors required to meet any accreditation standards? How are these assessed?
5d. Are supervisors required to complete any training programs related to their role as student, trainee
5e. If so, does your facility provide funding for this training?
Page 227 of 235
6. In your opinion, are there any skills that supervisors require but are generally lacking?
6a. Are any of these skills particularly important in the private sector?
Records, policies and guidelines
7. Does you facility keep records or a database of student, trainee and intern supervisors?
training?)
8. Are you aware of policies or guidelines within your facility that apply to student, trainee or intern
Final comments
Prompt
•
discussed earlier?
Page 228 of 235
Training institution-specific interviews
Introduction
1. I understand that you are a <insert profession> working at <institution> training <insert student
discipline/s>. The aim of this mapping study is to determine how supervision is organised within the
private health sector. As such, I ask that you answer these questions from the perspective of your
institution.
1a. Within your <institution>, for what disciplines are you able to provide information on student, trainee
or intern supervision?
Relationships with private health facilities
2. Can you provide an overview of how the clinical placement of students, trainees and interns is arranged
between your educational institution and private health facilities?
2a. Does your educational institution provide or fund a supervisor/facilitator position within the facility?
2b. Does your educational institution provide guidance or training on how to supervise their students,
trainees or interns?
Supervision in the clinical workplace
3. Can you provide an overview of how the supervision of students, trainees and interns is conducted
within private health facilities?
3c. What is the general duration of a student’s clinical placement? (e.g. weeks, months, full time)
3d. Does the provision of supervision to your students differ between public and private health
facilities?
Supervisor skill and experience
4. What level of experience and skill do you generally require of supervisors in order to supervise
students, trainees or interns in the workplace?
4a. Are supervisors required to meet any accreditation standards? How are these assessed?
4b. Are supervisors required to complete any training programs related to their role as student, trainee
4c. If so, does your institution provide this training, or funding for this training?
Records, policies and guidelines
5. Does you institution keep records or a database of student, trainee and intern supervisors?
training?)
6. Are you aware of policies or guidelines produced by your institution that apply to student, trainee or
intern supervision? If yes, please provide details.
Final comments
Page 229 of 235
Prompt
•
discussed earlier?
Page 230 of 235
APPENDIX XI: PRIVATE SECTOR PROFILE ELECTRONIC SURVEY
PREAMBLE
The NSW CSSP Clinical Supervision Mapping Study is being undertaken by the Health Education and Training
Institute (HETI)*
A key component of the NSW Clinical Supervision Mapping Study is the conduct of a survey of student, trainee and
intern supervision which seeks to inform the development of a profile of student, trainee and intern supervisors across
allied health, dental, medicine, midwifery and nursing in the NSW health sector (public and private).
The information captured through this survey will be used to develop a strategy for training in the clinical workplace
that will aim to increase patient safety and quality of care through increased supervision support and capacity.
It is acknowledged that across allied health, dental, medicine, midwifery and nursing, the definition of supervisor and
supervision in a clinical context vary (for example, in nursing and midwifery, the term supervisor may refer to the role
of facilitator and/or preceptor).
PLEASE NOTE: This survey has previously been circulated in the public health sector, and is now being circulated in
the private health sector. If you have already completed this survey, you do not need to complete it a second time.
*As an outcome of the DirectorGeneral’s
Governance Review on the future directions for NSW Health completed in
October 2011, the Clinical Education and Training Institute (CETI) has been restructured to become the Health
Education and Training Institute (HETI).
For the purposes of this survey:
• Students, trainees and interns refer to those individuals undertaking education and training in a clinical placement within the health sector. The term is
inclusive of:
 students currently undertaking study through a university or VET college; AND
 students who have graduated, but are required to complete a set amount of work experience (years, hours) in order to attain registration; OR
 students who have graduated and are provisionally registered (e.g. medical graduates in their PGY1 year, who are provisionally registered).
• Supervision of students, trainees and interns refers to the oversight of professional procedures and/or processes performed in the clinical workplace.
Supervision is provided for the purpose of guiding, providing feedback on, and assessing the personal, professional and educational development of
• A supervisor of students, trainees or interns is an appropriately qualified and recognised professional, who guides student, trainee or intern education and
training during clinical placements.
Page 231 of 235
INTRODUCTORY QUESTION
Survey question
Response option/type
Notes
1. In the past 12 months, have you provided supervision
for any of the following groups as part of your role?
University, VET or private college students
Trainees
Interns
YES/NO
If yes, respondents continue
on path A.
If no, respondents continue
on path B.
PATH A: STUDENT, TRAINEE AND INTERN SUPERVISORS
The following questions relate to the supervision you provide to the group(s) you identified in Question 1
Survey question
Setting scope
Select from drop down list of:
Allied health
Dentistry
Medicine
Midwifery
Nursing
Other, please specify _________________
3. Approximately how many years (full time equivalent)
experience do you have working as a clinician?
Multiple choice:
Less than 5 years
Between 5 and 10 years
More than 20 years
4. Approximately how many years (full time equivalent)
experience do you have in providing supervision for
students, trainees or interns?
Multiple choice:
Less than 1 year
More than 20 years
5. Is this provision of student, trainee or intern supervision a
formally recognised part of your role?
YES/NO/UNSURE
Page 232 of 235
Survey question
6. Have you completed any training specific to your role as a
student, trainee or intern supervisor?
YES
NO
7. If yes, which of the following best describes the type of
training you have received?
Select from:
Other TAFE or VET college course
University degree or diploma in supervision
Training program or seminar run by a university
Training program or seminar run by a health facility
Other (please specify) ______________
8. The following list identifies some of the core skills required
by supervisors of students, trainees and interns. Please
select up to THREE skills that you feel are the MOST
IMPORTANT to supervision.
Self evaluation and reflection
Other (please specify) _______________
9. Please identify any areas in which you would benefit from
additional training. Please select up to THREE areas only.
Self evaluation and reflection
Other (please specify) _______________
I do not have capacity to provide any more supervision
I have capacity to provide more supervision and I am interested in doing so
I have capacity to provide more supervision, but I am not interested in doing so
Unsure
11. Which of the following factors influence your capacity to
provide supervision to students, trainees or interns?
Page 233 of 235
Survey question
Access to training
Other (please specify) ________________
12. Would you be interested in completing a training course
specific to your role as a supervisor of students, trainees or
interns?
YES
NO
13. If yes, please describe what your 'ideal' training course
would look like.
You may like to consider HOW the course is delivered (e.g.
online, face to face) and WHAT the course would cover (e.g.
ways to balance supervision and your workload)
Free text response
PATH B: NOT CURRENTLY A STUDENT, TRAINEE AND INTERN SUPERVISOR
Survey question
Setting scope
2. In the past, have you ever been involved in the
supervision of students, trainee or interns?
YES/NO/UNSURE
Select from drop down list of:
Allied health
Dentistry
Medicine
Midwifery
Nursing
Other, please specify _________________
I do not have capacity to provide any more supervision
I have capacity to provide more supervision and I am interested in doing so
I have capacity to provide more supervision, but I am not interested in doing so
Unsure
Page 234 of 235
Survey question
5. If you are interested in providing supervision, which of the
following factors currently prevent you from doing so?
Access to training
Other (please specify) ________________
6. What would help to increase your capacity to provide
supervision to students, trainees and interns?
Free text response
BOTH PATH A AND B
What is your age?
Select from age ranges:
Less than 20 years
20–29 years
30–39 years
40–49 years
50–59 years
60 years or older
What is your gender?
Male or Female
Do you also work in a public health service/setting?
YES/NO
Page 235 of 235

NSW Clinical Supervision Support Project Mapping Study

Transcription

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