Enhancing the quality of telesupervision to better support the rural health workforce

The COVID-19 pandemic has triggered increased use of videoconferencing and health professionals are using digital platforms more in recent times to undertake clinical supervision, a form of professional support. This is called telesupervision or e-supervision, which denotes the use of technology – including phone, email, Teams, Zoom, Skype or FaceTime – to undertake clinical supervision.

Supervision is intended to not only enhance the supervisee’s skills and knowledge, but also to support them through times of stress and change. Historically, face-to-face clinical supervision enjoyed ‘best option’ status. However, this wasn’t an option for many health professionals working in the bush given the workforce instability, small team size and sole practitioner positions. Hence, for this group, telesupervision has been the only option, even prior to the pandemic.

Access to platforms such as Teams and Zoom on personal computers and smartphones has made it easier for many health professionals to switch from using phone (where there is an absence of visual cues) to using video (the better method) to connect with their supervisors. This is especially important for those in new supervisory relationships and for those wishing to demonstrate, teach or practice a hands-on skill or technique such as applying a splint or performing an X-ray. With patient consent, the supervisee is even able to bring them in during the supervision session to get advice and guidance from the supervisor at the other end.

However, some rural health professionals simply resort to using their phones for supervision due to issues with the internet and lack of a private or confidential space to undertake telesupervision using a videoconferencing platform. Some others stick with the phone as they fit supervision into their travel time during outreach. This can be risky, as previous research has shown that important clinical elements such as hands-on practice may get missed in telesupervision, especially when only the phone is used. For new graduates and those new to a role, this may adversely impact their clinical skills and knowledge, which could have a flow-on effect on the quality of patient care.

So, what can be done to ensure high quality telesupervision?

For the supervisee and supervisor:

• choosing videoconferencing methods over phone
• incorporating hands-on practice, chart audits and patient sessions within telesupervision – in other words, moving beyond merely discussing things
• prioritising and quarantining time for supervision, so that it is planned in advance
• using a peer at the supervisee’s end to demonstrate or practice a technique during the session so that the supervisor can observe and provide feedback
• utilising opportunistic moments to have face-to-face sessions such as during a conference or a networking event.

For an organisation and management:

• promoting a positive supervision culture by ensuring access to supervision time and resources (including good internet and meeting rooms)
• provision of professional development opportunities to promote high quality, evidence-informed telesupervision practices
• conducting audits to ensure adherence to clinical supervision policies and guidelines.

Telesupervision research prior to the pandemic was scarce. Since the pandemic, some studies have identified that positive supervisory relationships and prior face-to-face contact can enhance telesupervision quality. My postdoctoral research on the impact of the pandemic on clinical supervision in rural health settings is investigating the factors that can improve telesupervision quality. While waiting for more evidence in this area, we can make better use of already available guidelines on setting up effective telesupervision arrangements, which my PhD research contributed to.

The key is moving away from ad hoc, unstructured, convenient methods to intentional, planned, well-structured telesupervision sessions, using videoconferencing and a variety of learning methods. This will not only enhance health professionals’ skills, knowledge and support, it will also contribute to better quality health care for patients in the bush.