in this issue

The changing role of family practice supervisor

In this issue, Wearne et al. report how they tackled the problem of synthesising conclusions from a very heterogeneous evidence-base to answer the question ‘‘what are the roles of the clinical supervisors of family practice (FP) resident doctors?’’ In contrast to the most favoured previous definition of clinical supervision, which emphasises ‘‘monitoring and providing feedback’’, published evidence shows how supervisors support residents as they learn from the challenge of caring for patients. The relationship between a resident and a supervisor can be thought of as an ‘‘educational alliance’’. It is essential that the ability of FP supervisors to develop and sustain supportive supervisory relationships with FP residents is preserved.

Wearne S, Dornan T, Teunissen PW, Skinner T. General practitioners as supervisors in postgraduate clinical education. An integrative review. Med Educ 2012; 46: 1161–73.

Clinical reasoning: a different viewpoint

Despite consensus that clinical reasoning is a central activity in the health professions, it is still not clearly understood. Through Dialogism, Loftus offers a way to integrate insights from a range of theoretical models that promise a more useful means of articulating and understanding clinical reasoning. Improving comprehension of the complex interactions of the discourses of health care professionals, clinical practice and patients can lead to the critical engagement of ideas and improvements in the teaching and the practice of clinical reasoning.

Loftus S. Rethinking Clinical Reasoning: time for a dialogical turn. Med Educ 2012; 46: 1174–78.

Effects of adverse events on surgeons

This study by Luu et al. explores surgeons’ reactions to adverse events and their impact on subsequent judgement and decision making. Using a constructivist grounded theory approach, Luu et al. conducted individual 60 minute semi-structured interviews with 20 surgeons to explore their reactions to past adverse events in their clinical practice. Subsequently, closely following their experiences of an adverse event, six general surgeons from outside the original group were interviewed. Analysis of the responses received suggests that, contrary to previous suggestions, surgeons’ reactions to adverse events follow a trajectory similar to that of members of other medical professions. Their findings have implications for surgeons learning, well being and surgeon error.

Luu S, Patel P, St-Martin L, Leung ASO, Regehr G, Murnaghan ML, Gallinger S, Moulton C-a. Waking up the next morning: surgeons’ emotional reactions to adverse events. Med Educ 2012; 46: 1179–88.

How are core competencies addressed during clinical supervision?

Saucier et al. explored how core competencies are taught and learned during clinical supervision in a family medicine residency programme, from both the residents’ and the preceptors’ perspective. Core competencies were regularly addressed, but implicitly, intuitively and often unconsciously. Content and process issues were equally influential on the discussion of core competencies, as highlighted in facilitators and barriers identified. This article suggests practical strategies to move to more competency-oriented supervision, namely fostering learner’s engagement.

Saucier D, Paré L, Cote L, Baillargeon L. How core competencies are taught during clinical supervision: participatory action research in family medicine. Med Educ 2012; 46: 1194–1205.