Genetic counseling supervisor strategies: An elaboration of the Reciprocal‐Engagement Model of Supervision

Abstract

Clinical supervision plays a key role in the training of genetic counselor practitioners. The Reciprocal‐Engagement Model of Supervision (REM‐S) is a recently published model of genetic counseling supervision centered on the supervisor–student relationship. The REM‐S comprises five tenets and 16 goals that reciprocally interact to achieve three broad supervision outcomes. Lacking, however, is a comprehensive set of supervisor strategies that correspond to the tenets and goals. This study aimed to elaborate the REM‐S by identifying strategies genetic counselor supervisors use to accomplish each REM‐S goal when they supervise students in clinical rotations. Nineteen prenatal, pediatric, and cancer genetic counselor supervisors from clinics in a major Midwestern city participated in one of three focus groups. Eleven semistructured questions were asked about strategies they use when attempting to accomplish each REM‐S goal. Directed content analysis yielded a total of 14 different strategy domains that vary in their frequency for accomplishing each REM‐S goal. Participants identified between nine and 13 strategy domains for each goal. Across all REM‐S goals, the most frequent strategy domains are: Assess student; Practice self‐reflection to increase supervisor self‐awareness; and Establish student goals and expectations. The present findings elaborate the REM‐S by identifying supervisor strategies corresponding to the REM‐S goals. These strategies can inform training in clinical supervision, and they can be the focus of observational studies designed to identify supervisor behaviors that characterize each strategy.

Supervision in genetic counselor training in North America: A systematic review

“…The SWA is the collaboration between the trainee and supervisor to create trainee change based on mutual agreement of the goals and tasks of supervision, and includes a strong emotional bond (Ladany & Friedlander, ). Specifically, the supervisor can attempt to build rapport, create a bond, or otherwise get to know the student to build the supervisory relationship (Suguitan et al, ). The supervisory relationship is important because, when strong, students feel less stress (Caldwell, Wusik, He, Yager, & Atzinger, ; Gnilka, Chang, & Dew, ), less role conflict or role ambiguity (Ladany & Friedlander, ), are more able to cope, are more willing to trust the supervisors’ feedback, and feel less anxious while with patients and the supervisor (MacFarlane et al, ).…”

“…Several of the papers included in this systematic review either directly or indirectly noted that peer supervision related specifically to supervision skills could be beneficial for improving GC supervision. For example, GC supervisors learn better supervision techniques through consultation with others (Finley et al, ; Lindh et al, ; Suguitan et al, ). This is also supported by the ACGC practice‐based competencies, which note that genetic counselors should be involved in active reflection of one's supervision experiences (Doyle et al, ).…”

“…GC supervision training could: Begin with a review of the known models of supervision (Borders et al, ; Venne & Coleman, ; Wherley et al, ). This should include definitions of Millennial learners, scaffolding (including examples), and authentic learning (Atzinger et al, ; Suguitan et al, ). Provide a copy of the GC supervision competencies (Eubanks‐Higgins et al, ). These can be interrogated prior to the training to find those with the lowest self‐efficacy among supervisors.…”

“…Training can then be tailored accordingly (Atzinger et al, ; Finley et al, ). Previous lowly rated competencies or issues included: I can respond to a student's thoughts regarding their clinical skills in a manner that enhances the supervision process and I can elicit a student's feelings regarding their clinical skills ; I can use the ABGC practice‐based competencies to set goals; and I can identify learning needs of a student at various levels of experience (Finley et al, ). Supervisor struggles, including difficult student personalities (Hendrickson et al, ; Venne & Coleman, ) Disagreement on student skill level (Atzinger et al, ). Working with novice versus advanced students in clinical rotations (Eubanks Higgins et al, ) Evaluation and supervision methods (Eubanks Higgins et al, ) Discuss the supervisory working alliance and strategies to strengthen the relationship between GC supervisor and student (Berg et al, ; Caldwell et al, ; Eubanks Higgins et al, ; MacFarlane et al, ; Suguitan et al, ). Discuss creative ways to reduce the amount of time genetic counselors need to spend in supervision (Berg et al, ). This can include discussion of other methods of supervision besides live supervision, such as listening to recordings at 1.5× speed or student self‐report, depending on the developmental level of the student (Hendrickson et al, ; MacFarlane et al, ; Masunga et al, ; McCarthy & LeRoy, ). Include information about the particular GC program.…”

“…Finley et al (2016) found that increased numbers of supervised students led to a more self-efficacious supervisor in their supervisory skills. Suguitan, McCarthy Veach, LeRoy, Wherley, and Redlinger-Grosse (2019) looked at a different aspect of GC supervision -what strategies do supervisors use to attain the Goals and Tenets of the REM-S supervision model. They found 14 strategy domains that supervisors use to help students.…”