Supervision svarende til behov: Når professionslogik møder produktionslogik

Abstract

It is crucial for patients and for the reputation of the healthcare system, that healthcare professionals receive relevant, high-quality training. The quality of medical specialist training depends to a large extent on the educational efforts at the individual hospital wards. This dissertation focuses on supervision and the fact, that junior doctors express an experience of inadequate supervision corresponding to their daily needs as part of their specialist training at Danish hospitals. The study is designed as a case study. The empirical material was obtained at two clinical departments at Bispebjerg Hospital in the Capital Region of Denmark. Six semi-structured interviews and three full-day observations were performed. All respondents were junior doctors. Data analysis was performed as
thematic analysis. Notes from observations were used to highlight factors of relevance to supervision. Respondents were offered full anonymity and the option to approve the use of citations to ensure validity in the survey.
The study shows that junior doctors at the beginning of their specialist training have different needs than doctors further ahead. The diverse needs are decisive for the experience of having one's needs met. There are needs concerning instructive supervision, reflective supervision, and formal teaching. There are needs for academic discussions and professional affirmation. Some needs are not accommodated by the current supervision options, which primarily consists of an instructive form of supervision. Junior doctors' organizational understanding also has an impact on their experience of adequate supervision. A great insight into the organization provides an eye for alternative sources and opportunities for supervision. Inadequate supervision is linked to high complexity work tasks, workload and to the fact, that supervision is available on demand but is not a fixed part of the work plan. High workload reduces the access to supervision and affects the ability to give and receive learning. When a junior doctor experience inadequate supervision, it leads to dysfunctional effects. Junior doctors adopt routines, habits, and workflows that get them through the day, but are ineffective in both a professional and business-like sense. In addition, junior doctors show signs of crowding-out when they fail to seek supervision despite a pronounced desire to learn.