15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June How do Danish GPS benefit from SUPERVISION? RED-II. Educational models and supervision Location: Háskólabíó - Hall 4 Thursday 14th June 14:05 PM

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June How do Danish GPS benefit from SUPERVISION? Part of a qualitative research project, which will be extended to a PhD-study: What is good supervision for GPs? Research unit of general practice Center for Sundhed og Samfund 5, Øster Farimagsgade, P.O. box 2099 DK-1014 Copenhagen K Denmark

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June WHAT IS SUPERVISION?

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June EDUCATION?

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June PSYCHOTHERAPY?

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June SUPERVISION GROUPS IN DENMARK - HISTORY Danish GPs have been attending supervision groups since the 1970s Primary aim has been managing mental health problems in general practice

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June WHAT WAS THE TASK? 1. Managing the doctor-patient relationship - inspiration psychotherapy 2. Consultation skills of everyday practice – inspiration medical education

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June SUPERVISION IN DENMARK IN THE FUTURE From 2007 supervision groups will be implemented in the final year of vocational training for registrars in family medicine The aim is to train reflective practice and support professional development

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June SHARING MENTAL HEALTH CARE Newer reports and guidelines in Denmark recommend supervision of GPs as part of shared care in mental health

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June WHAT IS GOOD SUPERVISION FOR GPs? Aim of the study To describe clinical supervision in general practice, and to look at the needs for supervision of Danish GPs based on their own context.

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June METHOD I have used qualitative methods using participant observation in depth interviewing of key informants group interview.

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June ANALYSIS The tape recorded interviews have been transcribed verbatim by myself and analyzed according to a method inspired by Giorgi and modified by Kirsti Malterud. The computer programme Nvivo was used to handle the data.

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June Some preliminary results focusing on outcome DIVERSITY WELLKNOWN BENEFITS NON-SPECIFIC BENEFITS IMMEDIATE BENEFITS LONGTERM BENEFITS

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June DIVERSITY A scratch in the varnish Or A personal change

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June WELLKNOWN BENEFITS Communicative skills professional competence Greater job satisfaction Personal development Prevention of burnout (Rasmussen PB, Bentzen K: Superviseret samtalebehandling. Lægeforeningens forlag 1997 Krøll V og Folmer E: Supervision til praktiserende læger – betydning og udbytte Ringkøbing amt 2002)

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June NON-SPECIFIC BENEFITS it seems to be a useful approach for me …It was a great relief deep inside myself that it was all right not to be perfect..... it makes sense for me…...I could recognize many things......it is nice to present your case without anybody saying you ought to do this or that... Another perspective Relief Recognition Inside understanding Being listened to and seen Witnessing

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June IMMEDIATE BENEFITS Relief Bodily relaxation The joy of experiencing new insight Advice asked for Challenges

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June LONGTERM BENEFITS Professional identity Skills Professional development

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June IN WHICH WAY DID THEY BENEFIT? In a safe and secure learning environment: Training interviewing Training empathetic skills Imitating colleagues Getting advice Being recognised and contained by colleagues and the supervisor Learning about stress reducing activities

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June CONCLUSION This study shows that GPs may benefit from joining supervision groups in many ways. Non- specific benefits may be of as much importance as learning communicative skills and contribute likewise to professional development. GPs are differing and benefit in variable ways. Being in a safe group in a safe learning environment is of significance as is the professionalism of the supervisor.

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June THANK YOU FOR YOUR ATTENTION!

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June SLIDES IN CASE OF MORE TIME

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June THEMES FOR THE ONGOING STUDY What does frame of reference mean for the outcome? What is the most important benefit for the GPs themselves? How does professional development happen? How does supervision contribute to burnout prevention? Are their harmful factors in supervision, which should be avoided?

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June Do we have scientific knowledge about supervision? Some research has been done on balint groups. Research has been done about educational supervision - mostly individual supervision Other professions have done research on supervision – especially nurses Very little research has been conducted on group supervision, still less on group supervision for GPs.

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June MATERIAL : 262 pages of text Notes from participant observations from 3 supervision sessions Notes from thoughts and reflections in between 6 Short interviews immediately after the supervision 5 In depth interviews with case presenters 1 group interview with this supervision group 1 short and 1 in depth interview with the supervisor of this group 1 in depth interview with a balint trained GP In depth interviews with 2 GPs who are not participating in a supervision group

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June HOW DID I ANALYSE THE DATA? I read the text thoroughly in the beginning listening to the record at the same time trying to be so open minded as possible : What was said? Which were the themes? How was it said? Meanings? The first categories : Profession Relations The supervision Professional life Private life Self care Modalities Outcome

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June PROFESSIONAL COMPETENCE The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. (Epstein RM and Hundert EM, JAMA 2002)

15th Nordic congress of general practice Reykjavik, Iceland June, 2007 Helena Galina Nielsen Thursday 14. June WHICH BENEFITS WERE MOST IMPORTANT? To my opinion: Coping with stress Communicative skills Professional support and development