Supervisor trainees' and their supervisors' perceptions of attainment of knowledge and skills. An empirical evaluation of a psychotherapy supervisor training programme

Objectives. This study aimed to evaluate the success of a two-year, part-time training programme for psychotherapy supervisors. A second aim was to examine factors that might contribute to perceived knowledge and skills attainment during the training course. Design. This is a naturalistic, longitudinal study where several measures are used to examine group process and outcome. Methods. Supervisor trainees’ (n=21) and their facilitators’ (n=6) ratings of learning (knowledge and skills), relations to the supervisor and supervision group, usage of the group, and supervisor style were completed at three time points. Results. The findings suggested that both trainees and their supervisors perceived that the trainees attained a substantial amount of knowledge and skills during the course. In accordance with the literature and expectations, the regression analysis suggested a strong negative association between a strong focus on group processes in the initial and middle phases of the training and perceived knowledge and skills attainment in the final phase of the training. The expected, positive role of relations among trainees in the supervision group in the first half of the training and perceived knowledge and skills attainment in the final part of the training was obtained, whilst the hypothesized significance of the relationship between trainee and supervisor did not receive support. Conclusions The supervisory course seemed to provide a training that allowed trainees to attain knowledge and skills that are necessary for psychotherapy supervisors. The results of this pilot study also emphasize the need of more research on learning in the context of group supervision in psychotherapy

Group supervision : Learning psychotherapy in a small group format

Group supervision in psychotherapy is today, in Sweden as well as internationally, a common form of supervision. Nevertheless, few systematic studies have been carried out in this field. There is an increasing demand for a more thorough understanding of the specific factors involved in group supervision. This thesis aimed at illuminating some aspects of the learning process in psychodynamically oriented group supervision: the experience of the role as supervisee and supervisor, likewise the experience of group climate and foci of content and, further, their relation to attained psychotherapeutic skill. To this end four studies were carried out using 1) a standardised method SYMLOG to illuminate and compare role patterns, 2) an explorative study to illuminate the experience of the group's inner life, 3) a modified Swedish version (MSES) of the Buckley Self Evaluation Scale to explore the experinces of attained skill after group supervision, and finally 4) a newly constructed questionnarie (TAC) to illuminate foci of content of the supervision and, further, the experience of group climate. Supervisees' as well as supervisors' points of view have been taken into account; although the experiences of the supervisees have constituted the foreground. According to SYMLOG self-ratings made by supervision groups in two psychotherapy training programmes at different levels, there were no differences in role patterns between supervisees at different training levels, whereas the differences between the supervisors and the supervisees, independent of training level were highly significant. Evidently, it was just as difficult to find one's voice and role in a supervision group at an advanced level as at a basic training level. Concerning the experiences of the supervision group, explored in two studies on a basic training level, both supervisees and supervisors reported that individual supervisee factors, as well as factors related to the group composition, exerted a decisive influence on the experiences of the group climate. The importance of interventions on a group level adjusting the group climate was emphasised. Group dynamics were central and remained as an intense experience long after the termination of the supervision. Using MSES self evaluation scale for assessment of attained psychotherapeutic Skill, and Change of skill after supervision, three domains of skill were interpreted: Containing emotionally loaded therapeutic issues, Mastery of working alliance, and Psychodynamic understanding. There were significant increases in Skill in all these dimensions, and significant positive Changes of skill. When supervisors evaluated Change of skill they tended to give higher ratings than the supervisees. Significant correlations of slightly more than medium size between supervisor and supervisee ratings of Change were obtained. Skill, according to ratings in the dimension of Mastery of working alliance made by supervisees after supervision, was related to group supervisor. Themes of group supervision content (Part A) as well as the group climate (Part B) were assessed using the questionnaire TAC. Four factors were interpreted in Part A: Group processes Psychodynamic processes, Professional attitudes, and Theoretical aspects, and two factors in Part B: Openness and creativity and Insecurity and competition (the latter factor was omitted due to a low Alpha level). The focus on Psychodynamic processes received the highest and over time increasing ratings and, moreover, showed a broad effect on the experience of attained skill. Professional attitudes were also considered to be a basic theme. The foci on Group processes and Theoretical aspects had a positive and negative effect, respectively, on the Skill factor Containing emotionally loaded therapeutic issues. The prevalence of these two foci was related to group supervisor. The Group climate factor, Openness and creativity, did not seem to affect the supervisees' experiences of attained skill. However, the evaluations of Openness and creativity of the final supervision period differed due to group supervisor. Study 3 and 4 were carried out on an extensive sample of supervisees and supervisors on a basic level training programme from three Swedish universities

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London