ABSTRACT

The aim of this study is to investigate the experiences of clinical supervisors and their perceptions of their role and the factors that affect them via two key variables: confidence and satisfaction.

This communication explores the descriptive data collated in this study. A survey was distributed via Facebook, the BVNA and by direct email to RCVS Training Practices. The study gained ethical approval from the SSREB committee at the Royal Veterinary College URN SR2020-022.

Most clinical supervisors (75%) were keen, or very keen, to take on their role. Practical skills acquisition was the focus for clinical supervisors, and motivation, commitment and willingness were attributes in students that clinical supervisors felt were most important. This study provides a baseline understanding of the perceptions of clinical supervisors and the factors that affect them, which is of interest to employers, education providers, clinical supervisors and veterinary nursing students.

Key words clinical supervisor, clinical supervision, clinical coach, student veterinary nurse, veterinary education

Introduction

In order to join the Register of Veterinary Nurses, governed by the Royal College of Veterinary Surgeons (RCVS), student veterinary nurses (SVNs) must achieve approved standards of academic understanding and competency in a set list of skills (RCVS, 2021). This includes a requirement to complete 1,800 hours of clinical training in an RCVS-approved Training Practice for all qualification routes, under the supervision of a clinical supervisor (commonly referred to as clinical coaches or clinical assessors). A clinical supervisor can be a registered veterinary nurse (RVN), or veterinary surgeon (VS) who must be a Member of the Royal College of Veterinary Surgeons.

The clinical supervisor is responsible for mentoring the SVN through their practical training. They are a contact point for both the SVN and the training provider and are essential to the progression of the future profession. Without a clinical supervisor, an SVN cannot commence or complete their clinical training and therefore cannot graduate as an RVN. Yet, despite their important role in the training of SVNs, minimal studies have explored RVN experiences of clinical supervision.

This study explored general perceptions of the role and analysed two variables relating to clinical supervision: firstly, confidence within the role and secondly, role satisfaction. This information is presented over a three part series, with this communication describing the initial descriptive findings.  

Gaining a broader understanding of the perceptions of the clinical supervisors’ roles will allow training providers and veterinary practices to identify issues and, if required, provide greater support to the clinical supervisors responsible for training veterinary nursing students. There are reported issues in medical nursing relating to a lack of confidence to fail students, dubbed ‘failing to fail’ (Hughes et al., 2016) and it is not known if the same occurs within the veterinary profession.

Holt et al. (2021) reviewed what the clinical coaches considered their roles to be, the further education they had undertaken, how long they had been qualified before undertaking their training, and how many students on average they supported – all of which were explored within this study. The results from this study will be compared to the recent 2021 findings to provide further depth to this area of understanding. 

Aims

The aim of this study was to investigate the experiences of clinical supervisors and their perceptions of their role, in addition to the factors that affect them.  

Objectives

1. To determine the demographics of clinical supervisors with regards to: 

a. Role in the veterinary practice (RVN/MRCVS)

b. Prior experience in education

c. Reasons for no longer supporting students

d. Length of time spent as a clinical supervisor

2. To determine the motivation for becoming a clinical supervisor, for example:

a. Prior interest in becoming a clinical supervisor

b. If participants are asked or ask to become clinical supervisors

c. Time taken to become a clinical supervisor from qualification

d. Time to take on students following qualification

e. Educational qualifications undertaken prior or post clinical supervisor training

3. To determine the perceptions of the role with regard to:

a. What the clinical supervisor feels their main roles are 

b. What the clinical supervisor thinks students believe their main roles to be

c. What attributes the clinical supervisors believe are required for a student to be successful

d. If the clinical supervisor feels supported by practice

e. If the clinical supervisor feels supported by training provider (the student’s college or university)

f. Where support is accessible from  

Methodology

DATA COLLECTION METHOD 

This study utilised Jisc survey software to distribute a questionnaire containing 29 questions, which was divided into sections as presented in the results. It utilised multiple choice, numerical and Likert response format questions, with an ‘other’ option when expansion was required. An open question was provided at the end to allow participants to provide any additional information.

PARTICIPANT RECRUITMENT

The participant inclusion criteria were VSs or RVNs in the UK who had undertaken clinical supervision training. The survey was distributed via Facebook, the BVNA and by direct email to RCVS Training Practices (through the RCVS ‘find a vet’ website and via a freedom of information request).

Participants were required to consent to the study after reading an information sheet which declared a potential conflict of interest, i.e., both researchers work at a teaching institution. No identifying personal data was collected from participants to reduce response bias due to this.

A sample size calculation was not completed as the total number of clinical supervisors working within the UK is currently unknown. The researchers attempted to quantify this unknown number by contacting the training centres detailed by the RCVS (RCVS, 2020). Ten out of the 50 training centres replied, and the combined number of clinical supervisors was 1,245 (range from responses 33–554).  

ETHICAL APPROVAL

The study gained ethical approval from the SSREB committee at the Royal Veterinary College URN SR2020-022. No ethical issues were identified, and no personal data were collected. Participants read an information sheet prior to consenting to participate.

Results

There were 301 responses, two of which were removed due to incomplete responses to all questions. Of the 299 responses, 6% (N = 17) of participants were VSs and 93% (N = 278) were RVNs. 1% (N = 4) of participants did not respond to this question and their responses were omitted from analysis. Therefore, 295 participant responses were analysed unless stated otherwise.  

Participants were asked in which practice type they worked. 73% (N = 216) of participants stated that they worked in a first opinion general practice, 11% (N = 31) worked in a first opinion hospital, 9% (N = 25) worked in a referral hospital, 4% (N = 13) worked in a university hospital and 1% (N = 3) of participants worked in a charity practice. 2% (N = 7)
of participants selected ‘other’. The survey attracted responses from across the UK – detailed in Table 1. 

CURRENT SUPPORT OF STUDENTS

Participants were asked if they were still supporting students in the veterinary practice. 87% (N = 258) were and 13% (N = 37) of clinical supervisors that responded to this survey were no longer supporting students. The latter were asked to provide a response as to why. Their responses were grouped:

• The respondent is now a locum or no longer in the veterinary practice (32%, N = 12)

• Practice Covid-19 restrictions (26%, N = 10)

• Limitations on student number at the practice (18%, N = 7)

• Additional roles within the practice (11%, N = 4)

• High caseload (5%, N = 2)

• Taking a rest period (3%, N = 1)

• Personal feelings regarding training students (3%, N = 1)

THE ROUTE TO BECOMING A CLINICAL SUPERVISOR

Participants were asked if they wanted to become a clinical supervisor. 37% (N = 108) of participants were ‘very keen’ to become a clinical supervisor, 38% (N = 111) were ‘keen’, 16% (N = 48) were ‘indifferent’, 8% (N = 23) ‘would have preferred not to have become a clinical supervisor’ and 1% (N = 5) ‘did not want to be a clinical supervisor’. 

Participants were asked how they decided to become a clinical supervisor. The most frequent answer selected 56% (N = 166) was: ‘I was asked by the practice to become a clinical supervisor and I wanted to’. This is further explored in Figure 1.  

CLINICAL SUPERVISOR AND TEACHING EDUCATION

A range of questions relating to clinical supervisors’ own education were asked. 21% (N = 62) of participants had undertaken education-focused qualifications prior to becoming a clinical supervisor, with the most frequently reported answer being the A1 assessor qualification 87% (N = 54).

A minority, 6% (N = 19) of participants had undertaken additional education-focused qualifications since their clinical supervisor training, with the most common qualifications reported as the Post Graduate Certificate in Veterinary Education 26% (N = 5) and Level 3 Award in Education and Training (PTTLs) 26% (N = 5).

Participants were also asked how long they were qualified before undertaking clinical supervisor training. 294 participants responded to this question: 76% (N = 224) were qualified over a year before they became a clinical supervisor, (median of 3 years, range 1–40 years). The remainder (24%, N = 70) were qualified for less than a year before becoming a clinical supervisor, (median of 6 months, range 1–11 months). 

Participants were then asked how long they have been a clinical supervisor. 89% (N = 263) of participants had been a clinical supervisor for more than a year, (median of 5 years, range 1–34 years). The remaining 11% (N = 32) had been a clinical supervisor for less than a year, (median of 6 months, range 1–11 months). 

Finally, participants were asked how long the period was between their clinical supervisor training and them supporting a student. 69% (N = 204) supported a student immediately (within 4 weeks), 23% (N = 69) supported students soon after training (within 6 months), 3% (N = 8) supported students a while after training (between 6 months and a year) and 5% (N = 14) supported their students over one year later.

Table 2 explores the perceptions of the additional post-clinical supervision training on their role in supporting students.

THE ROLE OF THE CLINICAL SUPERVISOR  

Participants were asked to select what they felt were within their duties as a clinical supervisor. The most selected duty was practical skills acquisition (NPL) 99% (N = 294), followed by role modelling 95% (N = 279) and personal/pastoral support 90% (N = 266). When asked to select the key role of the clinical supervisor, the order of the top three remained the same.

When participants were then asked what they feel students think their role entailed. Practical skills acquisition (including NPL) was again the most selected answer 93% (N = 273, followed by completion of placement documentation 59% (N = 173). Application of academic knowledge (including help with assignments) was third 54% (N = 160). Again, practical skills acquisition (including NPL completion) was the most selected answer 88% (N = 259) when participants were asked to pick just one of the above choices. 

STUDENT ATTRIBUTES

Participants were asked to select the top three attributes that they feel are required for a successful SVN. Motivation was the most selected 66% (N = 196), followed by commitment 63% (N = 185), and willingness 35% (N = 102).

SUPPORT IN CLINICAL SUPERVISION

Participants were then asked about the support they receive in their role, starting with how well supported they felt, as detailed in Table 3.

They were then asked where they gained support from: 47% (N = 139) of respondents selected that they gained support from the training provider, followed by the practice team 41% (N = 121), and other clinical supervisors within the team 35% (N = 103).

FINAL COMMENTS

Participants were asked if they had any final comments they would like to raise: 57 participants added extra information and similar answers were grouped. The top three themes were:  

• A need for enhanced support from the teaching provider 19% (N =11)

• A need for time to support students 14% (N = 8)

• A need for recognition of the work conducted 10% (N = 6), but clinical supervisors loved their roles 10% (N = 6)

Discussion

This study has provided a baseline for a portion of the vast knowledge gap that exists on clinical supervisors, useful to a range of stakeholders. A full discussion will be provided over the three-part series, with the following focused on the descriptive data presented.

While there are no centralised data on the demographic of clinical supervisors, this study’s population reflected the experiences of practice, with greater numbers of respondents being RVNs in first-opinion practice. Most clinical supervisors had been qualified for over a year before undertaking their training, with a median of 3 years – similar to the 2.2 years noted by Holt et al. (2021). 

It is clear from this study that practical skills acquisition is thought to be the focus for clinical supervisors, which aligns to the main purpose of their existence and is comparable to the results presented by Holt et al. (2021). Role modelling and personal support were also key themes, partially correlating with the participants in the McIntosh et al., (2013) study in human nursing and, again, Holt et al. (2021). Interestingly, this aligned to the areas that supervisors felt both most and least confident in,
discussed in the second communication in this series. 

It was felt that students believe completing placement documentation and help with academic assignments is also of importance for the clinical supervisor to assist with. As assessment is considered to drive learning (Wormald et al., 2009), and the NPL, assignments and placement documentation are all linked to assessment, this seems logical. Further exploration of the students’ views of this is required to compare if these perceptions of each other’s priorities are accurate and if any differences between the two impact the working relationship and students’ success. 

This study also explored the attributes that clinical supervisors felt were key to a successful student. Motivation, commitment and willingness were deemed to be the most important, comparable to those reported by supervisors of medical nurses (McIntosh et al., 2014). It is again something that needs to be correlated to student outcomes. However, it is useful for training providers, employers and prospective students to know the general attributes that clinical supervisors desire in their students. 

Motivated clinical supervisors are important too. It was encouraging to see that most respondents, 75% (n = 219), were keen or very keen to take on their role. Although most were asked to take on the role and did not suggest this themselves, the majority of SVN’s supported by participants of this study are being trained by someone who wished to undertake this role. 

Most clinical supervisors felt somewhat supported by the practice and generally supported by the college or university. However, enhanced support from the training providers was also frequently requested in the final question of this study, which is unsurprising considering 47.5% of clinical coaches in a previous study felt they were unprepared following their training (Holt et al., 2021). 

Participants were also asked to evaluate how they felt the prior or additional training had supported their clinical supervision. Of those participants who had undertaken prior qualifications (21%, n = 71) and post-training qualifications (6%, n = 19), it was felt their experience as clinical supervisors was improved. The 6% (n = 19) of respondents who completed post-clinical supervisor training/qualifications felt they had a positive impact on their experiences as clinical supervisors, with 68% selecting that they agreed to some extent that their additional qualifications had improved their overall experience of the role. Again, the effects of these qualifications on the students’ progression requires review. Whether further training would be beneficial for all clinical supervisors and additional satisfaction factors are explored in Part 2 of this study. 

References

Holt, S. L., Vivian, S. R., & Brown, H. (2021). Training and preparedness of clinical coaches for their role in training student veterinary nurses in the United Kingdom: An exploratory inquiry. Journal of Veterinary Medical Education, e20200100. https://doi.org/10.3138/jvme-2020-0100

Hughes, L. J., Mitchell, M., & Johnston, A. N. B. (2016). ‘Failure to fail’ in nursing – A catch phrase or a real issue? A systematic integrative literature review. Nurse Education in Practice, 20, 54–63. https://doi.org/10.1016/j. nepr.2016.06.009

McIntosh, A., Gidman, J., & Smith, D. (2014). Mentors’ perceptions and experiences of supporting student nurses in practice. International Journal of Nursing Practice, 20(4), 360–365. https://onlinelibrary.wiley.com/ doi/10.1111/ijn.12163

RCVS [homepage on the internet]. (2021). List of RCVS accredited further education qualifications in veterinary nursing; c2020 [cited April 30, 2021]. https://www.rcvs.org.uk/document-library/list-of-rcvs-accredited-furthereducation-qualifications-in/

RCVS [homepage on the internet]. (2021). TP handbook;c2017 [cited April 30, 2021]. https://www.rcvs.org.uk/news-and-views/ publications/tp-handbook/

RCVS [homepage on the internet]. (2021). Training Routes; c2020 [cited April 30, 2021]. https://animalowners.rcvs.org.uk/veterinar y-careers/i-want-to-be-a-veterinary-nurse/training-routes/

Wormald, B. W., Schoeman, S., Somasunderam, A., & Penn, M. (2009). Assessment drives learning: An unavoidable truth? Anatomical Sciences Education, 2(5), 199–204. https://doi.org/10.1002/ase.102