Amee Guide No. 27: Effective Educational

2007; 29: 2–19

AMEE Guide No. 27: Effective educational
and clinical supervision
SUE KILMINSTER1, DAVID COTTRELL1, JANET GRANT2 & BRIAN JOLLY3
1

University of Leeds, UK, 2Open University Centre for Education in Medicine, UK, 3University of Monash, Australia

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

Introduction
Why the Guide?
What is good educational supervision and who are the good
supervisors? Documentation from the UK Department of
Health (DoH 1996) and...