Call for clinical supervision

Following the suicide of one of our colleagues, it is only right that we examine the culture of medicine and seek answers. Others have written brave and heartfelt pieces about their experiences. There has been a call, and a response, for the provision of greater resources for mental health for doctors. It is clear that there is a need for better pastoral care and support for professionals.

As revealed in the National Mental Health Survey of Doctors and Medical Students, “the general work experience for Australian doctors is stressful and demanding.” Additionally, that there are high levels of emotional exhaustion, cynicism and low professional efficacy reported, all three of which are indicators of burn out. Young doctors and female doctors, in particular, report higher levels of work stress and appear to have greater levels of general and specific mental health problems. These surveys pinpoint the early years of training, during the transition from medical school to postgraduate training, as critical periods of mental distress.

I cannot speak on behalf of all junior doctors, as we each have a different experience of medicine. Nor do I intend to go over the multifaceted reasons why change is needed. My intention is only to put forward the idea of clinical supervision for junior doctors as a means of improving the support structure for junior doctors.

The AMA position statement provides an outline for the provision of supervision of postgraduate medical trainees. The need for increased pastoral care in our professional lives could be met by an expanded view of this current supervision model. There are many models of clinical supervision in use, and the use of clinical supervision in psychiatry training and for all mental health clinicians is well established.

The purpose of clinical supervision is to provide a professional relationship between two clinicians with the aim of providing a safe and trusting relationship in which the supervisee can reflect on clinical practice. It is different from the informal structure of mentoring relationships or the more formal and feedback-oriented supervisor roles that we are all familiar with. It is an entirely professional and supportive relationship, set up within the clinical framework and designed to help develop the clinical and emotional skill set of the trainee by encouraging them to reflect on their clinical encounters, their interactions with colleagues and to guide them in their personal development. Some of us are intuitive, self-reflective and insightful by nature and others of us need help to nurture these qualities. Turning our attention to clinical supervision and to extension of the existing skills and expertise of supervisors could well be important. It is time that we allocated resources to the promotion of these personal and professional skills and to the support of clinicians.

There are many models of clinical supervision, and whilst no single model stands out as universally applicable, it is my hope that we could expand the current models of supervision that we employ. I wonder whether an expanded definition of clinical supervision could lower the rates of cynicism and emotional exhaustion described by junior doctors in the beyondblue surveys. If so, it is a solution that could have far-reaching benefits for each of us and for our patients.