In this month’s research news we focus in on power dynamics in supervision (“you don’t know the power of the dark side”…), conflict (queue light saber sound), uncertainty (I think) and on the very big difference you make on your patients’ BP.

Read on!

Power dynamics in clinical supervision

It’s often named as the reason why registrars don’t talk about what they perceive to be a poor experience of supervision and a whole range of other things.

The power differential in the supervisory relationship is undeniable but as these authors propose, it can be used positively or negatively.

So what are these aspects of power and from whence do they originate? This paper describes a study, again in clinical psychology, where 9 supervisees were interviewed in depth.

The results identified 5 categories.

An important source of power is the supervisor’s advanced knowledge and experience. This seems obvious and was agreed by all participants.

Unrecognised and unacknowledged supervisor errors erode the perception of expert power. These errors might be clinical, ethical or administrative.

Perceived misuses of power evoke self-preservation in supervisees. This is where the trainee can revert to turning off from the supervisory process in order to preserve their self-esteem or prevent further disappointment. So maybe that disengaged registrar’s behavior is trying to tell you something?

Power is shared when the supervisor demonstrates trust in the supervisee’s ability. This demonstration was often in the form of taking a more collaborative approach with the trainee.

Supervisor’s transparency and nurturance reduces the power differential. Ok so the language is a bit psychologically-oriented but the concept is the same. Roughly translated this seems to be getting at supervisors being able to share their own perceived weaknesses and uncertainty with their trainee.

Any of this ringing bells for you?

A framework for addressing supervisor-supervisee value conflict

Ever had a conflict with a registrar that was about values?

Well this paper from Clinical Supervisor proposes a framework that just might help.

The framework was developed in clinical psychology for managing value conflicts between psychologists and clients, but the framework itself has been adapted by the authors who think it may be useful in any discipline.

The framework is: Detect-Articulate-Respond (DAR).

Would it work in general practice? You be the judge! Tell us what you think. I’d love to know. Drop me an email!

Dunn R, Callahan JL. A proposed framework for addressing supervisee-supervisor value conflict. Clinical Supervisor, 2017:36(2).

I’m not sure about this one…

Fascinating paper in Medical Education on the tolerance of uncertainty among GP registrars.

This is yet another paper emerging from the ReCEnT data collection (the study that keeps on giving!).

Seems there are different phenotypes for it! Wow! I didn’t even know there was a gene for it!! My genetics degree has seriously let me down here!

The two ‘phenotypes’ are those with a high affective response to uncertainty, and those reluctant to disclose uncertainty to patients.

The affective aspects of uncertainty were associated with being: female, less experience in hospital prior to commencing GP training and graduation overseas.

The maladaptive response to uncertainty (i.e. reluctance to disclose) was associated with urban practice, health qualifications prior to studying medicine, practice in an area of higher socio-economic status and being Australian-trained.

Read it hear, unless you’re unsure…

“About your blood pressure …”

Ever doubted that all that emphasis on communications skills in training is worth it?

Interesting paper in this month’s Medical Teacher encourages you to keep it up if you want to have a positive impact on hypertension outcomes.

This was a RCT conducted in Iran that showed that brief communications skills training for health providers seems to improve patient-provider communications skills AND improve hypertension outcomes in those with uncontrolled BP.

The intervention consisted of attendance at 3 focus group discussions and 2 training workshops. “Too much!” I hear you say but the results are quite impressive with SBP dropping by some 21 points and diastolic by 13.

Read all about it here:

And that’s it for 2017!

If you have any comments to make, suggestions, or even good articles you want to share with your colleagues please let me know at

Wishing you all season’s greetings and see you in 2018!

Date reviewed: 31 October 2018

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