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How core competencies are taught during clinical supervision: participatory action research in family medicine

Authors


Danielle Saucier, Département de Médecine Familiale et Médecine d’Urgence, Faculté de Médecine, Pavillon Vandry, Local 4617, Université Laval, 1050 Avenue de la Médecine, Quebec City, Quebec G1V 0A6, Canada. Tel: 00 1 418 656 2131 (ext. 8723); Fax: 00 1 418 656 5252; E-mail: danielle.saucier@mfa.ulaval.ca

Abstract

Medical Education 2012: 46: 1194–1205

Objectives  The development of professional competence is the main goal of residency training. Clinical supervision is the most commonly used teaching and learning method for the development of core competencies (CCs). The literature provides little information on how to encourage the learning of CCs through supervision. We undertook an exploratory study to describe if and how CCs were addressed during supervision in a family medicine residency programme.

Methods  We selected a participatory action research design to engage participants in exploring their precepting practices. Eleven volunteer faculty staff and six residents from a large family medicine residency programme took part in a 9-month process which included three focus group encounters alternating with data gathering during supervision. We used mostly qualitative methods for data collection and analysis, with thematic content analysis, triangulation of sources and of researchers, and member checking.

Results  Participants realised that they addressed all CCs listed as programme outcomes during clinical supervision, albeit implicitly and intuitively, and often unconsciously and superficially. We identified a series of factors that influenced the discussion of CCs: (i) CCs must be both known and valued; (ii) discussion of CCs occurs in a constant adaptation to numerous contextual factors, such as residents’ characteristics; (iii) the teaching and learning of CCs is influenced by six challenges in the preceptor–resident interaction, such as residents’ active engagement, and (iv) coherence with other curricular elements contributes to learning about CCs. Differences between residents’ and preceptors’ perspectives are discussed.

Conclusions  This is the first descriptive study focusing on the teaching of CCs during clinical supervision, as experienced in a family medicine residency programme. Content and process issues were equally influential on the discussion of CCs. Our findings led to a representation of factors determining the teaching and learning of CCs in supervision, and suggest directions for research, for faculty development, and for interventions with learners.

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