Kilminster S M, Jolly B C
Department of Medical Education, University of Sheffield, Northern General Hospital, Sheffield, UK.
Med Educ. 2000 Oct;34(10):827-40. doi: 10.1046/j.1365-2923.2000.00758.x.
Clinical supervision has a vital role in postgraduate and, to some extent, undergraduate medical education. However it is probably the least investigated, discussed and developed aspect of clinical education. This large-scale, interdisciplinary review of literature addressing supervision is the first from a medical education perspective.
To review the literature on effective supervision in practice settings in order to identify what is known about effective supervision.
The empirical basis of the literature is discussed and the literature reviewed to identify understandings and definitions of supervision and its purpose; theoretical models of supervision; availability, structure and content of supervision; effective supervision; skills and qualities of effective supervisors; and supervisor training and its effectiveness.
The evidence only partially answers our original questions and suggests others. The supervision relationship is probably the single most important factor for the effectiveness of supervision, more important than the supervisory methods used. Feedback is essential and must be clear. It is important that the trainee has some control over and input into the supervisory process. Finding sufficient time for supervision can be a problem. Trainee behaviours and attitudes towards supervision require more investigation; some behaviours are detrimental both to patient care and learning. Current supervisory practice in medicine has very little empirical or theoretical basis. This review demonstrates the need for more structured and methodologically sound programmes of research into supervision in practice settings so that detailed models of effective supervision can be developed and thereby inform practice.
临床督导在研究生医学教育中起着至关重要的作用，在一定程度上对本科医学教育也很重要。然而，它可能是临床教育中研究最少、讨论最少且发展最不完善的方面。这次从医学教育角度对文献进行的大规模跨学科综述是首次此类研究。
回顾关于实践环境中有效督导的文献，以确定对有效督导的了解。
讨论了文献的实证基础，并对文献进行了综述，以确定对督导及其目的的理解和定义；督导的理论模型；督导的可用性、结构和内容；有效督导；有效督导者的技能和素质；以及督导培训及其效果。
证据仅部分回答了我们最初的问题，并提出了其他问题。督导关系可能是督导有效性的最重要单一因素，比所使用的督导方法更重要。反馈至关重要且必须清晰。学员对督导过程有一定的控制权并能参与其中很重要。找到足够的督导时间可能是个问题。学员对督导的行为和态度需要更多研究；有些行为对患者护理和学习都有害。当前医学领域的督导实践几乎没有实证或理论基础。本次综述表明，需要在实践环境中开展更具结构性且方法合理的督导研究项目，以便能开发出有效的督导详细模型，从而为实践提供指导。
