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Objectives. A systematic review was undertaken of studies that have assessed objectively the impact of supervision and consultancy. As well as gauging effectiveness, we examined the methodological rigour of these studies.

Method. Twenty-eight empirical studies of the change processes occurring between participants within the educational pyramid, ‘consultant [RIGHTWARDS ARROW] supervisor’, ‘supervisor [RIGHTWARDS ARROW] supervisee’ and ‘supervisee [RIGHTWARDS ARROW] patient’, were analysed. The inclusion criteria also required that supervision was analysed under field conditions and there were objective measures of learning outcomes. Each study was analysed by reference to an evaluation manual, with two independent raters obtaining satisfactory reliability.

Results. Studies meeting the above criteria came mainly from the intellectual disability specialty and included many studies using cognitive-behavioural methodologies. The studies included in this sample had more rigorous methodologies than those reviewed by Ellis, Ladany, Krengel, and Schult (1996). The findings of the review suggested that the pyramid approach benefited patients. Closely monitoring the supervisee, modelling competence, providing specific instructions, goal setting and providing contingent feedback on performance were the dominant methods of supervision and were associated with benefits to supervisees.

Conclusion. Despite the large body of literature on supervision, there have been relatively few empirical investigations of the educational pyramid. This work identified a number of studies with good methodological rigour, although these too often failed to provide adequate background and assessment details regarding each of the members of the pyramid, particularly the consultant. The results of cognitivebehavioural supervision were found to be positive.