Remote and Rural Healthcare Education Alliance

In support of the development of the Rural Workplace Practice Supervision Hub that will in turn support the Rural Advanced Practice qualification being developed in partnership with the University of the Highlands and Islands, we were keen to carry out a ‘light touch’ review of existing literature around remote and rural practice supervision. Literature and case studies from across the globe were included in the search to gain the broadest possible background to this development. The search centred on practice in remote and rural contexts but included all health and social care disciplines. It was not constrained by the practice experiences of either the supervisors or the supervisees. Articles published within the last 20 years were prioritised in the review. 

Immediately notable was the paucity of available literature relating to remote and rural supervision. Eight relevant articles were selected for review, of which seven were available as full texts. One of these articles is an integrative review which synthesises 43 additional papers that examine support interventions for healthcare practitioners in remote and rural contexts. 

The relative dearth of literature around supervision in remote and rural contexts suggests a lack of rigorous research into supervision in non-metropolitan settings. Up to 98% of the land mass of Scotland is considered rural and accommodates around 17% of the Scottish population. The development of the Rural Workplace Practice Supervision Hub is therefore an ideal opportunity to contribute to the field of remote and rural research with Scottish evidence-based literature relating to practice supervision. 

Supervision in remote and rural areas was identified as important for supervisors and supervisees for the following reasons: 

Supervisees	Stakeholders
Enhanced confidence	Improved clinical governance
Improved clinical skills	Enhanced staff retention
Increased knowledge	Best practice outcomes
Reduced isolation	Patient safety
Enhanced professional enthusiasm

 

 

 

 

 

Key factors for success (also referred to as ‘enablers’) were identified in the reviewed articles, and these were compiled into the table below. Any duplicate entries were removed, and any similar entries were combined ensuring no detail was lost.

Supervisors	Supervisees	General
Proactive approach to setting learning goals	Ability to handle uncertainty	Supervisor-supervisee 'fit'
Documenting governance	Sound knowledge of the community	Positive supervision culture
Willingness to explore potential 'blind spots' of the supervisee	Willingness to learn and grow	Optimal and effective use of technology
Willingness to be available by phone or email (crucial at-distance factor)	No hesitation in asking questions	Making time for supervision
Extensive experience in remote and rural medicine	Resilience	Organisational commitment to supervision
Clear discussion about the purpose of supervision	Ability to take responsibility for their own learning and limitations	Workplace setting
Personalised approach to supervision between supervisor and supervisee	Choice of supervisor	Use of blended supervision models
Importance of underpinning a process of reflection	Personalised approach to supervision between supervisor and supervisee	Support for supervisors with their practical skills and theoretical knowledge
		Quality of relationship between organisation and education establishment(s)
		CPD opportunities provided by the universities, together with constructive feedback
		Acknowledgement by organisations of the responsibility associated with a supervisor role

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Key barriers to success were also identified as follows:

Supervisors	Supervisees	General
Supervisor-supervisee ‘fit’	Supervisor-supervisee ‘fit’	Time
Credentialing and professional requirements	Risk of supervision becoming a ‘therapy’ session rather than focusing on patient care – some clinical situations were ‘hijacked’ by complex personal issues	Competing clinical priorities
Poor attitudes of supervisors towards the supervisees		Lack of dedicated resources
Poor teaching and assessing skills of the supervisors		Lack of appropriate technology to allow ‘telesupervision’
Poor preparation and undervaluing the supervisor role (by the supervisors)		Poor communication and support from clinical managers and peers
		Poor communication between university and supervisors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References:

Collado-Ruano, J., Madroñero-Morillo, M. and Álvarez-González, F., 2019. Training transdisciplinary educators: Intercultural learning and regenerative practices in Ecuador. Studies in Philosophy and Education, 38(2), pp.177-194. 

Ducat, W., Martin, P., Kumar, S., Burge, V. and Abernathy, L., 2016. Oceans apart, yet connected: Findings from a qualitative study on professional supervision in rural and remote allied health services. Australian Journal of Rural Health, 24(1), pp.29-35. 

Hastings, S.L. and Cohn, T.J., 2013. Challenges and opportunities associated with rural mental health practice. Journal of Rural Mental Health, 37(1), p.37. 

Kenny, A. and Allenby, A., 2013. Implementing clinical supervision for Australian rural nurses. Nurse education in practice, 13(3), pp.165-169. 

Marlow, A.H. and Mather, C.A., 2017. Supervision of nursing students in rural environments: Engaging learning by teaching the teachers. Australian and International Journal of Rural Education, 27(3), pp.111-125. 

Martin, P., Baldock, K., Kumar, S. and Lizarondo, L., 2018. Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface. Australian Health Review, 43(6), pp.682-688. 

Martin, P., O’Sullivan, B., Taylor, C. and Wallace, G., 2022. Blended supervision models for post-graduate rural generalist medical training in Australia: An interview study. BMC Medical Education, 22(1), pp.1-9. 

Miller, T.W., Miller, J.M., Burton, D., Sprang, R. and Adams, J., 2003. Telehealth: A model for clinical supervision in allied health. Internet Journal of Allied Health Sciences and Practice, 1(2), p.6. 

Mills, J.E., Francis, K.L. and Bonner, A., 2005. Mentoring, clinical supervision and preceptoring: clarifying the conceptual definitions for Australian rural nurses. A review of the literature. Rural and remote health, 5(3), pp.1-10. 

Moran, A.M., Coyle, J., Pope, R., Boxall, D., Nancarrow, S.A. and Young, J., 2014. Supervision, support and mentoring interventions for health practitioners in rural and remote contexts: an integrative review and thematic synthesis of the literature to identify mechanisms for successful outcomes. Human resources for health, 12(1), pp.1-30. 

Trede, F., McEwen, C., Kenny, A. and O'Meara, P., 2014. Supervisors' experiences of workplace supervision of nursing and paramedic students in rural settings: a scoping review. Nurse education today, 34(5), pp.783-788. 

Wearne, S., 2005. General practice supervision at a distance-is it remotely possible?. Australian family physician, 34(12 Suppl).