This study draws attention to the very real possibility that supervisors' assessments are not as reliable or valid as professional psychology assumes. The study examines end-placement reports accrued over a 12-year period from 130 supervisors who rated performance in 291 field placements completed by 131 clinical psychology trainees. It is likely that supervisor ratings are affected by a leniency bias. Further, earlier placement ratings are poor predictors of subsequent placement ratings by different supervisors. Ratings on the 11 broad performance dimensions yield a single clinical skills factor within which items congregated into two clusters: Assessment and Intervention; and Interpersonal and Professional skills. Factors that contribute to supervisor bias and strategies to reduce bias and to enhance the value of supervisor ratings are discussed.

BackgroundEnsuring effective identification and management of sepsis is a healthcare priority in many countries. Recommendations for sepsis management in primary care have been produced, but in complex healthcare systems, an in-depth understanding of current system interactions and functioning is often essential before improvement interventions can be successfully designed and implemented. A structured participatory design approach to model a primary care system was employed to hypothesise gaps between work as intended and work delivered to inform improvement and implementation priorities for sepsis management.MethodsIn a Scottish regional health authority, multiple stakeholders were interviewed and the records of patients admitted from primary care to hospital with possible sepsis analysed. This identified the key work functions required to manage these patients successfully, the influence of system conditions (such as resource availability) and the resulting variability of function output. This information was used to model the system using the Functional Resonance Analysis Method (FRAM). The multiple stakeholder interviews also explored perspectives on system improvement needs which were subsequently themed. The FRAM model directed an expert group to reconcile improvement suggestions with current work systems and design an intervention to improve clinical management of sepsis.ResultsFourteen key system functions were identified, and a FRAM model was created. Variability was found in the output of all functions. The overall system purpose and improvement priorities were agreed. Improvement interventions were reconciled with the FRAM model of current work to understand how best to implement change, and a multi-component improvement intervention was designed.ConclusionsTraditional improvement approaches often focus on individual performance or a specific care process, rather than seeking to understand and improve overall performance in a complex system. The construction of the FRAM model facilitated an understanding of the complexity of interactions within the current system, how system conditions influence everyday sepsis management and how proposed interventions would work within the context of the current system. This directed the design of a multi-component improvement intervention that organisations could locally adapt and implement with the aim of improving overall system functioning and performance to improve sepsis management.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1164-x) contains supplementary material, which is available to authorized users.

linical supervision in psychology training and practice is a significant and growing need in the Australian and international contexts. This paper briefly reviews current models of supervision and critically examines their implications for current research and practice. Two significant problems with current supervision models are that they lack the specificity to translate into clinical practice and the empirical research to demonstrate supervision effectiveness. The objectives approach, a paradigm from curriculum design and educational research, is described and applied to the domain of clinical supervision. It is argued that the new approach enhances conceptual clarity and provides a framework that facilitates choice of appropriate supervision objectives and methods, assessment of trainee competence, and evaluation of supervision efficacy. Based on the theoretical framework, a pilot study that examined concordance between supervisor and trainee with regard to supervision objectives and methods was conducted and results are described.

No abstract

BackgroundInadequate checking of safety-critical issues can compromise care quality in general practice (GP) work settings. Adopting a systemic, methodical approach may lead to improved standardisation of processes and reliability of task performance, strengthening the safety systems concerned. This study aimed to revise, modify and test the content and relevance of a previously validated safety checklist to the current GP context.MethodsA multimethod study was undertaken in Scottish GP involving: consensus building workshops with users and ‘experts’ to revise checklist content; regional testing of the modified checklist and follow-up usability evaluation survey of users. Quantitative data underwent descriptive statistical analyses and selected survey free-text comments are presented.ResultsA redesigned checklist tool consisting of eight themes (eg, medication safety) and 61 items (eg, out-of-date stock is appropriately disposed) was agreed by 53 users/experts with items reclassified as: mandatory (n=25), essential (n=24) and advisory (n=12). Totally 42/55 GPs tested the tool and submitted checklist data (76.4%). The mean aggregated results demonstrated 92.0% compliance with all 61 checklist items (range: 83.0%–98.0%) and 25/42 GP managers responded to the survey (59.5%) and reported high mean levels of agreement on the usefulness of the checklist (77.0%), ease of use (89.0%), learnability (94.0%) and satisfaction (78.4%).ConclusionsThe checklist was comprehensively redesigned as a practical safety monitoring and improvement tool for potential implementation in Scottish GP. Testing and evaluation demonstrated high levels of checklist content compliance and strong usability feedback, but some variation was evident indicating room for improvement in current safety-critical checking processes. The checklist should be of interest in similar GP settings internationally and to other areas of primary care practice.