Role of Supervision in Professional Training
Supervision is an important element in health professional training and practice and is central to the learning process
In December 2013, College Council approved a draft revised professional misconduct regulation for submission to government. The proposed draft regulation, which is currently under review by government, contains both new and revised provisions. One of the new provisions makes it an act of professional misconduct to fail to appropriately supervise a person whom the member is professionally, or legally, obligated to supervise. The addition of this condition into the draft regulation emphasizes the importance of supervision in protecting patient safety. This article will discuss the role of supervision in health professional training, review the instances in which supervision occurs in pharmacy practice, and identify some considerations for a member when responsible for supervision.
Supervision is an important element in health professional training and practice and is central to the learning process as it incorporates opportunities for self-evaluation as well as the development of analytical and reflective skills in the person being supervised. When the topic of supervision is raised in the context of the health professions, it is most often in relation to supervising students and interns; however, there are additional instances where supervision occurs. Supervision may be ordered where a member of a College requires mentorship to bring his or her practice up to the generally accepted standard of practice. Specific to pharmacy, the Designated Manager (DM) of a pharmacy is legally obligated to supervise pharmacy personnel, including both member and non-member staff.
Supervision of Students and Interns
The professional obligations of both pharmacists and pharmacy technicians are outlined in standards of practice and College policies and guidelines. Experiential learning is an important aspect of health professional training and helps to develop the competency of the student/intern, as demonstrated by the use of his or her knowledge, skills and abilities in providing patient care. Irrespective of the context in which students/interns are supervised, supervisors must ensure that they have the appropriate amount of time to allocate to this activity in order to provide an enriching experience for themselves and the student/interns.
A supervisor is expected to meet with a student/intern regularly to discuss the progress of his or her performance, give feedback on how to further develop competence, and provide formal assessments throughout the supervision period. The degree of oversight required by the student/intern can be adjusted as his or her professional judgment develops. Patient safety and the delivery of efficient and effective patient care is paramount, and will guide the supervisor’s determination of how much autonomy the student/intern will have in the execution of their duties. Also factoring into this consideration is the complexity of the patient’s condition and the level of risk in clinical decision-making.
The application of a model of graduated experiential learning will ensure that the student/intern is prepared to provide patient-centred care, which is dependent upon the development of clinical practice skills, critical thinking skills and decision-making skills under conditions of uncertainty. The supervisor has a great deal of latitude in the assignment of a student/intern’s duties and his or her autonomy. Documented assessments demonstrating the student/intern’s progress is evidence of the student/intern’s readiness to participate in enhanced practice opportunities. As the student/intern’s clinical judgment develops, he or she can be permitted to practice off-site and counsel patients, for example, by conducting a MedsCheck at home, with the availability of the supervisor for consultation by telephone as required.
Supervision of a Member’s Practice
Another aspect of supervision is that which follows a review of a member’s practice and finding that the level of care provided by the member has fallen below the acceptable standard. If this is the case, an order may be issued permitting a member to work only under the supervision of another member in good standing. The mentor will review the member’s practice, identify areas requiring remediation, develop a learning plan and monitor the member’s progress in meeting goals. In some cases, supervision may include standing side-by-side with the member in active practice situations. At the completion of the program, the results are reported to the College.
Supervision Duties of the DM
The duties of the DM are addressed both through legislation and College policy. The DM’s human resources duties are both functional and strategic. The DM is responsible for ensuring that staff members are fulfilling their duties and that they are providing good quality care. While regulated health professionals are responsible for their own practice, in a pharmacy the DM ensures that only a registered member, within the terms, conditions and limitations imposed on his or her certificate of registration, performs controlled acts. The DM must ensure that the staffing in the pharmacy supports the pharmacists(s) in their cognitive and patient care functions, and allows the pharmacists(s) to collaborate as needed with other health professionals.
Inter-professional Care
Given the adoption of shared scopes of health professional practice and the emphasis on the inter-disciplinary team in care delivery, new models of supervision are emerging. Regulations under the Pharmacy Act include a provision permitting the direct supervision of a pharmacy student by any regulated health professional in premises that is not a pharmacy, if within a clinical component of an education or training program. Regulation itself will need to adjust to the pressures of the future. A recent publication identified a number of trends that will have an impact on professional regulation (and supervision) in the near future.1 In addition to an emphasis on career-long competency and continuous quality improvement, expect a transition into an integrated and fluid regulatory process, with a greater emphasis on teams. How this trend to collaborative and joint accountability will be accomplished is uncertain, but it will be essential to maintaining the public trust.
Reference
- Steinecke Maciura LeBlanc. Grey Areas “A Futurist Looks at Professional Regulation” October 2013, Issue No. 180.