Clinical supervision of SpRs: where does it happen, when does it happen and is it effective?


Sue Kilminster, Research Officer, Medical Education Unit, School of Medicine, Level 7 Worsley Building, University of Leeds, Leeds LS2 9NN, UK. Tel: 00 44 113 233 1655; Fax: 00 44 113 233 4910; E-mail:


Objectives  To establish what supervisory methods are used in postgraduate medical education and to determine how effective, particularly in relation to patient care, these methods are perceived to be.

Design  We carried out a national validated questionnaire survey of medical directors (MDs) of National Health Service (NHS) trusts (both community and hospital), educational supervisors (ESs) and specialist registrars (SpRs).

Sample  Seven specialties were selected to represent the potential range of supervisory practices: anaesthesia, general practice, laboratory science, medicine, paediatrics, psychiatry and surgery. These involved 15 ESs and 15 SpRs from each specialty (n = 210) and 100 MDs.

Main outcome measures  Quantitative data were analysed using the following tests when appropriate: frequency counts, cross tabulations, descriptives, Kruskal–Wallis, Mann–Whitney, chi-square and Fisher exact tests. Qualitative data were also obtained.

Results  A total of 91% of SpRs had a formally designated ES. There was evidence of change in perceptions of the roles of supervising consultants. Supervisory practice is highly variable and there are significant differences between ESs and SpRs in perceptions of frequency and effectiveness of supervision. None of the supervisory activities, including ensuring patient safety, were rated as receiving significant or full coverage.

Conclusions  Supervision is considered to be both important and effective but there is inadequate coverage and frequency of supervision activities. At the least this indicates a need for more explicit guidance for ESs and SpRs.