Staff Perspective: Training and Clinical Competence - Understanding the Importance of Supervision

Staff Perspective: Training and Clinical Competence - Understanding the Importance of Supervision

Tim Rogers, Ph.D.

Training is something that we have all experienced as healthcare professionals.  We experienced training in our academic programs, our workplace settings, through continuing education requirements to maintain our licensing credentials, or as part of our professional development.   We engage in all of this training in order to achieve a desired level of competence.   However, after a training was completed how many of us have felt absolutely confident in our ability translate the knowledge we received into effective practice?  Did you ever feel like you needed more information (e.g., additional clarification, explanation, etc.) consultation or supervision in order to effectively implement the training you received?

Rahovshik et al. (2016) conducted an interesting study to examine the effects of supervision on Internet-based training of Cognitive Behavioral Therapy (CBT).  The authors set out to examine whether the demonstration of clinical competency post-CBT training would vary based on whether providers received supervision or not.   In the literature review, the authors note that results from previous studies show some positive effect from Internet-based training on therapists’ clinical competency as assessed by standardized role-plays in controlled research settings.  However, in designing their study, Rahovshik et al. (2016) deliberately utilized a sample of providers working in non-research settings (i.e., inpatient settings, independent practice, private clinics, government clinics, and university counseling centers) and assessed the effects of supervision on Internet-based training of CBT with actual patients. 

The authors sampled 61 mental health professionals (i.e., psychologists and psychiatrists) that were randomly assigned to one of three conditions: non-training control (i.e., waitlist group), Internet-based training with use of a consultation worksheet, or Internet-based supervision with Skype supervision.  The therapists in the Internet-based training of CBT received access to a 20-hour online CBT training program that they completed over the course of three months.  The training would cover three main components:  theory and case formulation, general CBT skills, and treatment protocols for Panic Disorder with Agoraphobia and Obsessive Compulsive Disorder.  Assessments of clinical competency were collected prior to the start of the study to establish a CBT competency baseline, halfway through the study, and at the end of the three-month training period.  The assessment of competency was conducted by having two blind reviewers evaluate videos of clinical sessions using Young and Beck’s (1988) 11 item Cognitive Therapy Scale (CTS).  The group receiving supervision in addition to the Internet-based training, received nine 30 minute supervision sessions (i.e., three supervision sessions per month) over the course of the study. The supervision focused on case formulation, general CBT skills, and implementation of the specific treatment protocols.

The results from the Rahovshik et al. (2016) demonstrated that supervision with Internet-based training had significant positive effects on CBT clinical competency.  No significant positive effects were found for the Internet-based training condition without supervision or the wait-list group.  The authors caution that multiple explanations for their particular findings may exist.  For example, the accountability associated with supervision might make individuals more engaged with their training and therefore produce higher levels of competency.  Additionally, since a majority of participants (i.e., 57%) rated themselves as having no CBT skills, it may be that the training by itself was not sufficient to help therapists overcome their lack of knowledge or experience with CBT.  The study does however suggest that Internet-based training alone may not be sufficient to produce a desired level of competency.

Implications for Training and Clinical Practice

With the movement towards competency-based assessments, dissemination and utilization of evidence-based practices, it becomes important to identify best practices for training.  The identification of such training practices, such as the use of supervision in conjunction with clinical training, helps to strengthen our expertise and delivery of high quality care for patients.  Future research should look at examining the effects of consultation compared to supervision on training, and the training methodology (i.e., online training versus in person training) on both short- and long-term competency of professionals and patient outcomes.  It may also be important to consider the objective of the training (e.g., refresher training versus learning a new skill or form of therapy).  To the extent that the training focuses on novel information, therapists may need to take additional steps to ensure the competency level of their professional practice.

Rakovshik, S. G., McManus, F., Vazquez-Montes, M., Muse, K., & Ougrin, D. (2016).  Is supervision necessary? Examining the effects of internet-based CBT training with and without supervision.  Journal of Consulting and Clinical Psychology, 84(3), 191-199.

Timothy Rogers, Ph.D. is a Deployment Behavioral Health Psychologist for the Center for Deployment Psychology (CDP) at Joint Base San Antonio-Lackland Texas.​