Professional Supervision in Sonography

By Gillian Coleman • Medical Ultrasound programme lead at the University of Derby

As a Sonographer and previously a Diagnostic Radiographer, I love my work and the many different patients that I have met and situations I have worked in. That said, over the years there has been many challenging situations, cases and patients that even to this day I remember the details of vividly. These moments in my career have stayed with me and I can recall exact details and how this affected me emotionally. I have often wondered why these situations have stayed with me. Is it because of the specific details that were harrowing? Was it because the situations carried an emotional burden which I as a professional took on? Is it because it resonated with personal circumstances?

I will probably never know why these patients’ stories stay with me but one thing that I have considered is the lack of ability to discuss and debrief from these cases after the imaging was completed. Impromptu conversations in the department with colleagues help with the processing of events but cannot be seen as the best way to debrief. There must be a better way for this to happen, surely? 

Whilst sitting in an interdepartmental meeting, I was listening to other allied health professionals talking about professional supervision and how this is utilised and incorporated into normal practice. I began to wonder what this process was and why we as radiographers / sonographers do not have this incorporated into our daily practice. Once investigating this further, I found there was very little guidance or research around this directly related to radiographers or sonographers.

In 2013, the Society of Radiographers published guidance on the use of professional supervision for the Radiographic workforce (The Society of Radiographers, 2013). Yet anecdotal evidence suggests that this guidance is not particularly known about or followed in many clinical Diagnostic Imaging settings. The HCPC also have guidance published on their website outlining how professional supervision can be supportive of professional development however this is not essential for registration (Health and Care Professions Council, 2021).

Within many allied health professions and within the wider healthcare workforce, professional supervision is an integral part of practice and yet it is suggested that this has never been widely adopted within the diagnostic radiography workforce. It is not particularly clear why this is the case.

Professional supervision is a formal process where two or more professionals can meet, discuss clinical practice and guidelines, reflect on practice and should include discussion of the emotional aspects of the role (Wallbank and Hatton, 2013). There are many different models discussed in the literature however the first and most widely utilised framework would be that first described by Brigid Proctor, commonly known as the Proctor model of supervision (Lynch et al., 2009).

Proctors’ model, as included in the Society of Radiographers guidance (2013) includes three domains. The formative domain includes elements of education, discussion of evidence-based practice and guidelines (Dawson et al., 2013). The normative domain includes discussion of professional standards and can support quality assurance processes (such as peer review) (Wallbank and Hatton, 2013). Finally the Restorative domain involves discussion of the emotional aspects of the supervisees role, general discussion around wellbeing and can support identifying signs of burnout (McCarron, 2018).

When we consider the sonographer role within the United Kingdom, sonographers work in a unique position where they perform the examination, report the findings and in the obstetric setting also discuss the scan findings with the patient. It is widely acknowledged that there is a national shortage of sonographers (The Society and College of Radiographers, 2019) and this adds to the pressure that the workforce is under alongside increased demand for imaging services. This coupled with the impact of the COVID-19 pandemic has led to a perfect storm of staffing pressures and reports of burnout within the profession. 

In a recent study by Skelton et al. (2022a), the level of burnout amongst sonographers during the pandemic was reported as over 90% of respondents. This has the potential for creating further pressure on the workforce as this study reported a significant proportion of respondents indicating that they intend to change their working practice within the next five years. 

Professional supervision can have a positive impact on quality of patient care (Wilson and Taylor, 2019) and can provide time to support reflection on practice (Fitzpatrick et al., 2017). Importantly though the research suggests that there can be other pressures which influence the effectiveness of supervision (Fitzpatrick et al., 2017; Martin et al., 2019). It is suggested that the supervisory relationship can impact the effectiveness and Fitzpatrick et al. (2015) found that where personality clashes occur, this can have a negative impact on the professional supervision process. Professional supervision can be effective when the provision is prioritised with a structured framework and the supervisee is placed at the centre of the process (Gardner, 2018; Fitzpatrick et al, 2017).

The sonographer workforce is in a critical position with staffing shortages and increased levels of burnout (Skelton et al., 2022a), coupled together with staff feeling a lack of support in the clinical setting (Skelton et al., 2022b). Now would seem the time to address these challenges and work towards providing better support mechanisms for sonographers in clinical practice. Professional supervision has the potential for providing the support required however further research within the UK setting is required to identify the best framework for professional supervision for sonographers. 

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Join the MedRadJClub chat on the topic of professional supervision on 23rd November (24th in Australia & New Zealand). You can find out more here

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References

Dawson, M., Phillips, B., Leggat, S. (2013) Clinical Supervision for Allied Health Professionals, A Systematic Review. J Allied Health. 42: 2: 65-73.

Fitzpatrick, S., Smith, M., Wilding, C. (2015) Clinical Supervision in Allied Health in Australia: A Model of Allied Health Clinical Supervision Based On Practitioner Experience. Internet J Allied Health Sci Pract. 13: 4: Article 13 pp1-13

Gardner, M.J., McKinstry, C., Perrin, B. (2018) Effectiveness of Allied Health Clinical Supervision. A Cross-Sectional Survey of Supervisees. J Allied Health. 47: 2: 126-132

Health and Care Professions Council (2021) Supervision, What our standards say. Website: What our Standards say | (hcpc-uk.org)

Lynch, L., Hancox, K., Happell, B., Parker, J. (2009) Clinical supervision for nurses. Wiley Blackwell, UK.

Martin, P., Baldock, K., Kumar, S., Lizarondo, L. (2019) Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface. Aust Health Rev. 43: 6: 682-688

McCarron, R.H., Eade, J., Delmage, E. (2018) The Experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement. J Psychiatr Ment Health Nurs. 25: 145-156.

Skelton, E., Harrison, G., Rutherford, M., Ayers, S., Malamateniou, C. (2022a) UK obstetric sonographers’ experiences of the COVID-19 pandemic: Burnout, role satisfaction and impact on clinical practice. Ultrasound. 0:0 (online first)

Skelton, E., Malamateniou, C., Harrison, G. (2022b) The Impact of the COVID-19 pandemic on clinical guidance and risk assessments, and the importance of effective leadership to support UK obstetric sonographers. Journal of Medical Imaging and Radiation Sciences 13:12 

The Society of Radiographers (2013) Professional Supervision – Advice and Guidance Document. 

The Society and College of Radiographers (2019) Ultrasound Workforce UK Census 2019. Accessed: ultrasound_workforce_uk_census_2019.pdf_2 (sor.org)

Wallbank, S., Hatton, S. (2011) Reducing burnout and stress: the effectiveness of clinical supervision. Community Practi. 84: 7: 31-35

Wilson, E., Taylor, N.F. (2019) Clinical Supervision for Allied Health Professionals Working in Community Health Care Settings. Barriers to Participation. J Allied Health. 48: 4: 270-276

Student Leadership

September’s blog is co-authored by Chris Gibson and Ben Potts. Both Chris and Ben are final year diagnostic radiography students, studying at Canterbury Christ Church University and Birmingham City University respectively. They are keen advocates for students in the medical radiation professions and in their blog they explore whether leadership is for students (spoiler: yes) and how can students “own it”?

This month’s #MedRadJClub chat prompt is an article by Nuzzo et al. [1] which suggests that there are always leaders in healthcare. That it is important for radiography students to recognise that “Everyone owns leadership” [2] and that leadership skills should be part of every healthcare worker’s toolkit and not just for those who might have leadership in a job title. This fits in with the themes of the Messenger Report [3] which pushed leadership as a way for increased collaboration and inclusion within the National Health Service (NHS) in the UK. It argued for the nurturing and development of leadership throughout an individual’s NHS career. This would help to get away from what Edmonstone [4] defines as a ‘managerialist ideology’ within healthcare leadership where people leading are often managers rather than leaders, again coming back to the ideas of the prompt paper. One way Edmonstone argues for this to be altered is for students to be offered practical leadership development opportunities as part of their programmes. There are already examples of this being implemented in the literature [5] and this idea would help to alter the prevailing culture around leadership within the NHS [6].

Healthcare students already have many voluntary leadership programs available to them, from the Florence Nightingale Foundation [7], Council of Deans 150 Leaders Program [8] or even the Edward Jenner Programme [9] which is available to aspiring leaders in the workforce as well as apprentices. The Society of Radiographers Student Forum also offers an excellent leadership opportunity that is not perhaps as formal as the ones listed above but both Ben and I have found excellent opportunities to develop under the guidance of Nichola Jamison. There are, surely, many more out there however, what links them all is that they are voluntary and require motivated students to apply. 

However, would putting leadership into undergraduate or apprenticeship training programs have a negative impact on students’ feelings and attitudes towards leadership? We have already seen the negative impact of including reflective practice essays on students [10]. How could we go about getting students who are not ready to apply externally for leadership opportunities to take their first steps towards being the leaders of tomorrow? How can students be expected to display leadership qualities during university or placement activities? Will having students engage in leadership activities improve the culture of positive and inclusive leadership within the NHS or healthcare workforce? To come back to the prompt article, how do we effectively transmit the message that “Everyone owns leadership” to students?

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Head over to the main site here for the chosen paper, chat themes and chat times

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References:

[1] Nuzzo, C., Girard, E., Xu, W.S., Wijaya, L., Karoonuthaisiri, N., Gray, F., and Jimenez, Y.A. (2022) ‘Opportunities to develop leadership skills in the undergraduate diagnostic radiography program: Insights from students at an Australian university’, Journal of Medical Imaging and Radiation Sciences, Available at: https://doi.org/10.1016/j.jmir.2022.08.003 (Accessed: 23 September 2022).

[2] Health Workforce Australia (HWA) (2013) ‘Australian health leadership framework. Available at: https://www.aims.org.au/documents/item/352 (Accessed: 23 September 2022).

[3] Department of Health and Social Care (2022) ‘Leadership of a collaborative and inclusive future’. Available at: https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-a-collaborative-and-inclusive-future/leadership-for-a-collaborative-and-inclusive-future#recommendations (Accessed: 6 August 2022).

[4] Edmonstone, J.E. (2017) ‘Escaping the healthcare leadership cul-de-sac’, Emerald Insight, 30(1), pp. 76-91, Available at: http://dx.doi.org/10.1108/LHS-02-2016-0012 (Accessed: 6 August 2022).

[5] Wu, A., Kielstein, H., Sakurai, T., Noel, G., Viranta-Kovanen, S., Chien, C-L., and Bernd, P. (2019) ‘Internationalization of Medical Education – Building a Program to Prepare Future Leaders in Healthcare’, Medical Science Educator, 29, pp. 535-547.

[6] Home, J., Jones, B., and Horton, T. (2022) ‘Reforming management and leadership in the NHS: Does the Messenger review go far enough?’, The Health Foundation, Available: https://www.health.org.uk/news-and-comment/blogs/reforming-management-and-leadership-in-the-nhs (Accessed: 6 August 2022).

[7] Florence Nightingale Foundation, Available at: https://florence-nightingale-foundation.org.uk/academy/leadership-development/leadership-programmes/ (Accessed: 6 August 2022).

[8] Council of Deans Student Leadership Programme, Available at: https://www.councilofdeans.org.uk/studentleadership/ (Accessed: 6 August 2022).

[9] NHS Edward Jenner Programme, Available at: https://www.leadershipacademy.nhs.uk/programmes/the-edward-jenner-programme/#:~:text=The%20Edward%20Jenner%20programme%20is,suite%20of%20online%20short%20courses (Accessed: 6 August 2022).

[10] Timmins, F., Murphy, M., Howe, R., and Dennehy, C. (2013) ‘“I Hate Gibb’s Reflective Cycle 1998” (Facebook © 2009): Registered Nurses’ Experiences of Supporting Nursing Students’ Reflective Practice in the Context of Student’s Public Commentary’, Procedia – Social and Behavioural Sciences, 93, pp. 1371 – 1375, Available: https://doi.org/10.1016/j.sbspro.2013.10.046 (Accessed: 6 August 2022).

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