Live Supervision Research Articles

Remote out-of-hours ultrasound live supervision in pediatrics - improvement of diagnostics and training.

Ultrasound (US) is the preferred imaging modality in pediatrics for diagnostic and therapeutic issues. The absence of radiation and the constant on-site accessibility make it the ideal tool for children. However, despite remarkable technical advances in resolution and applicability, many sophisticated medical questions still require profound expertise on the part of the examiner, thus often hampering fast decisions particularly outside regular working hours. This single-center study, at a university children's hospital evaluated the use of US during emergency service. A four-week documentation period was followed by a subsequent eight-week supervision period with live supervision availability on demand guided by a remote US expert. The demand for expert support, diagnosis, grading of urgency, duration and success of examination, and satisfaction of both examiners were analyzed. 108 patients (mean age 9.7 years) were included. In 38% of cases, US was supervised on demand with a definite diagnosis in 92.6% of cases (25/27). Image quality and technical performance were graded sufficient in 100% of cases. Supervised compared to non-supervised US examinations were prolonged (14.4 min vs. 7.1 min, p<0.001), were more prevalent within the first 24 h in the hospital (70% vs. 56.8%, p=0.06), and were classified more frequently as emergency (22.2% vs. 2.3%; p=0.015). All participants classified the availability of US supervision as decisively helpful. Remote live supervised pediatric US was feasible and effective. It combined timely, high-quality diagnostics even in the case of challenging medical questions with simultaneous US training.

Round-table Discussion “Around the EATA Handbook and Standards” with Boris Volodin and Elena Soboleva

This article contains a summary of the round table “Around the EATA Handbook and Standards” with the participation of Boris Volodin and Elena Soboleva, held on December 25, 2023. The main topic of discussion concerned the guidance from EATA and ITAA, and the topic of standards was also touched upon. In April 2023, changes were made to the guidelines, and this is what the speakers were talking about, telling in detail about the points that should be carefully considered. They also discussed the CTA exam, what has changed in the written exam, what is considered live supervision, and what are the current rules regarding online exams. In recent years, the world has undergone many changes that have affected everyone and our large global TA-community as well. In connection with this, there have been changes in the Handbook, it has not changed dramatically, especially the section about CTA, but these small changes need to be monitored, it is necessary to discuss with the supervisor. Also valuable was the discussion of the competence of professionals and understanding why everyone needs to familiarize themselves with the “EATA Training and Examination Handbook”. In 2025 there will be a World TA Conference from MATA and EATA, the meeting will be held in Montpellier (France). Participation in international conferences is mandatory for future certified professionals, it is also stated in the handbook.

Needs analysis for the design of a digital platform to train professionals in online family intervention through live supervision of real cases

PurposeMental health professionals undergo continuous training throughout their careers. Their training consists in part of the supervision of cases by an entire healthcare team, a practice that allows them to consolidate their understanding of behaviour, emotions and to enhance their relationships with patients and their families. The COVID-19 pandemic has had a great impact on this training methodology, leading to a significant increase in the use of digital platforms, but such digital tools are not well adapted to this context, especially when it comes to the supervision of real online cases. The goals of this study are: (1) to analyse what professionals need in order to carry out online interventions and training through the live supervision of real online cases and (2) to create a prototype of a specific digital platform intended to help meet the detected needs.Methods28 semi-structured interviews were conducted with supervisors (N = 14) and professionals in training (N = 14).ResultsThe results have allowed us to gain a deeper understanding of the difficulties and benefits that professionals are encountering when doing online live supervision using the existing video conference platforms.ConclusionThis analysis points to a need to create a platform that can overcome the difficulties and enhance the benefits of the digitalization of family intervention training through the live supervision of real cases. These specific needs have yet to be addressed by existing digital platforms.

Efficacy of live-supervision regarding skills, anxiety and self-efficacy: a randomized controlled trial

ABSTRACT Sixty-nine psychology students (M = 24.93 years, 82.6% female, 81% B.Sc. level) were randomly assigned to live supervision or a control group in an experiment with two simulated therapy sessions. In Session 1, their task was to conduct the beginning of a cognitive-behavioral therapy session with a standardized patient. In Session 2, all students repeated the task, but only one group received live supervision from a licensed psychotherapist. Live supervision improved students’ (observer-based) skills (ds ≥0.91), and students were satisfied with the feedback. In terms of self-efficacy and self-assessed skills, live supervision had no significant advantage over merely practicing.

Emergency pericardiocentesis in a district hospital with virtual live supervision

Emergency pericardiocentesis in a district hospital with virtual live supervision

Live supervision in psychotherapy training—A systematic review.

Live supervision in psychotherapy training—A systematic review.

Remote real-time supervision of prehospital point-of-care ultrasound: a feasibility study

BackgroundAlthough prehospital point-of-care ultrasound (POCUS) is gaining in importance, its rapid interpretation remains challenging in prehospital emergency situations. The technical development of remote real-time supervision potentially offers the possibility to support emergency medicine providers during prehospital emergency ultrasound. The aim of this study was to assess the feasibility of live data transmission and supervision of prehospital POCUS in an urban environment and so to improve patients’ safety.MethodsEmergency doctors with moderate ultrasound experience performed prehospital POCUS in emergency cases (n = 24) such as trauma, acute dyspnea or cardiac shock using the portable ultrasound device Lumify™. The ultrasound examination was remotely transmitted to an emergency ultrasound expert in the clinic for real-time supervision via a secure video and audio connection. Technical feasibility as well as quality of communication and live stream were analysed.ResultsPrehospital POCUS with remote real-time supervision was successfully performed in 17 patients (71%). In 3 cases, the expert was not available on time and in 1 case remote data transmission was not possible due to connection problems. In 3 cases tele-supervision was restricted to video only and no verbal communication was possible via the device itself due to power saving mode of the tablet.ConclusionRemote real-time supervision of prehospital POCUS in an urban environment is feasible most of the time with excellent image and communication quality.Trial registration: ClinicalTrials Number NCT04612816.

Training challenges and opportunities amid the COVID-19 pandemic: Perspectives from pediatric psychology interns.

Objective: The COVID-19 pandemic presented many personal and professional challenges to pediatric psychology interns as they navigated new policies and provided clinical care via telehealth to patients and families during an unprecedented time. Method: This commentary explores the experiences of 4 pediatric psychology interns and their training director during the height of the pandemic with an emphasis on challenges, opportunities, and lessons learned relevant to internship training. Results: There were numerous challenges in adapting and completing training during the pandemic, such as the rapid transition to telehealth, loss of training opportunities, providing care to inpatient and high-risk patients, and increased personal stress and social isolation. Despite these challenges, there were unique opportunities that arose. Interns were given opportunities to learn a new modality of care (telehealth), expand their breadth of training, practice innovation, receive live supervision in unobtrusive ways, and actively support their medical colleagues. Conclusions: Looking toward the future of health care, interns will significantly benefit from the skills learned during this pandemic, particularly as skills in providing evidence-based care via telehealth will continue to benefit psychologists seeking to increase access to care for patients and families. Institutions providing pediatric psychology internship training may also benefit from incorporating these training opportunities and lessons learned into future internship training in order to best support interns' professional and personal needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Navigating internship during a crisis (i.e., the COVID-19 pandemic) may present both challenges and opportunities for interns and training programs. Training programs may consider ways to adapt their programs to ensure that training competencies are addressed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Supplemental Material for Live Supervision in Psychotherapy Training—A Systematic Review

Supplemental Material for Live Supervision in Psychotherapy Training—A Systematic Review

Remote versus on-site proctored exam: comparing student results in a cross-sectional study

BackgroundThe COVID-19 pandemic has profoundly affected assessment practices in medical education necessitating distancing from the traditional classroom. However, safeguarding academic integrity is of particular importance for high-stakes medical exams. We utilised remote proctoring to administer safely and reliably a proficiency-test for admission to the Advanced Master of General Practice (AMGP). We compared exam results of the remote proctored exam group to those of the on-site proctored exam group.MethodsA cross-sectional design was adopted with candidates applying for admission to the AMGP. We developed and applied a proctoring software operating on three levels to register suspicious events: recording actions, analysing behaviour, and live supervision. We performed a Mann-Whitney U test to compare exam results from the remote proctored to the on-site proctored group. To get more insight into candidates’ perceptions about proctoring, a post-test questionnaire was administered. An exploratory factor analysis was performed to explore quantitative data, while qualitative data were thematically analysed.ResultsIn total, 472 (79%) candidates took the proficiency-test using the proctoring software, while 121 (20%) were on-site with live supervision. The results indicated that the proctoring type does not influence exam results. Out of 472 candidates, 304 filled in the post-test questionnaire. Two factors were extracted from the analysis and identified as candidates’ appreciation of proctoring and as emotional distress because of proctoring. Four themes were identified in the thematic analysis providing more insight on candidates’ emotional well-being.ConclusionsA comparison of exam results revealed that remote proctoring could be a viable solution for administering high-stakes medical exams. With regards to candidates’ educational experience, remote proctoring was met with mixed feelings. Potential privacy issues and increased test anxiety should be taken into consideration when choosing a proctoring protocol. Future research should explore generalizability of these results utilising other proctoring systems in medical education and in other educational settings.

Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study.

BackgroundThe COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates’ behaviors.ObjectiveWe aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure’s impact on exam scores.MethodsThe application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students’ exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation.ResultsOf the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent.ConclusionsThis pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates’ awareness of being monitored via a safe browser plug-in for exams.

The role of live supervision in the systemic psychotherapy training: a qualitative research

This paper explores the role of live supervision on the professional skills of young systemic psychotherapists. The Ecopsys Institute of systemic psychotherapy training considers the live supervision an essential experience of the training process. Each student joins the therapeutic session with the supervisor supported by the training group following behind the mirror (Loriedo C., 1989) through a closed-circuit audiovisual system, and then draws up a report, a tool for reflection on clinical thinking and acting. To investigate some aspects of the live supervision experience, a sample of 35 reports have been collected and analyzed with the T-Lab qualitative software, describing the emotional features of the first live consultation by students enrolled to different years and training groups. The textual analysis made it possible to point up the theoretical and clinical peculiarities of the Ecopsys Institute supervision model, focused on the emergence of emotional dimensions experienced by the supervisor-trainee dyad during live supervision.

Systemic supervision, the last frontier: Towards a scale that measures systemic supervision

This paper describes the development of a scale for measuring systemic supervision which is called the Systemic Supervision Rating Scale (the 3D‐SSRS). This scale was developed through a thematic synthesis of the systemic supervision literature, which included 137 papers on the subject. The scale was then subjected to a face validity investigation via a series of qualitative focus groups. These groups included both supervisors of supervision and students on an AFT Accredited Supervision training. Focus groups were held at the beginning and at the end of the course to understand how useful the 3D‐SSRS was to supervision practice. The 3D‐SSRS uses a seven‐point scale to rate supervision practice and prioritises qualitative comments in 11 dimensions, including the supervisory relationship, context of supervision, developmental stage of supervisee, development of systemic skills and thinking, and attention to power and difference.Practitioner points Systemic supervision draws on knowledges and skills unique to systemic practice within specific contexts. A new Systemic Supervision Rating Scale (the 3D‐SSRS) has been developed for use in clinical and training contexts of supervision. Initial investigations into the usefulness and face validity of the scale find it able to capture many of the unique aspects of systemic supervisory practice. More research is needed into what makes for effective live supervision, perhaps unique to systemic supervisory practice, and supervision provided to groups.

Guidelines for Integrating Live Supervision in Simulation-Based Clinical Education: An Example for Teaching Motivational Interviewing

During the past 20 years, social work education has built a bridge between the classroom and field using client simulation to learn clinical skills. This paper outlines an innovative model of simulation that incorporates LS used to teach motivational interviewing (MI). In addition, guidelines with specific steps for teaching MI with simulation and LS are discussed. Unfortunately, most present day simulation models leave out methods to instruct and supervise students in real time. When implementing clinical simulations there is little opportunity to correct a trainee’s behavior or to practice a new skill at the perfect teachable moment during an interview. This instruction must wait until the interview is finished and the debriefing has begun. With the addition of LS, the simulation experience is enhanced for students as the supervisor is now incorporated as an active participant in the interview. Using LS, the instructor can now direct and even model appropriate clinical responses and interventions. The use of simulation with LS is innovative and builds on social work’s evolving body of simulation-based education and further strengthens this approach. Results of this model suggest that students quickly learn to appreciate the value added of LS to simulation and that clinical skills learned resist decay overtime.

The journey towards digital systemic competence: Thoughts on training, supervision and competence evaluation

Our rituals for training, supervision and competence assessment which once relied on in‐person interaction are rapidly becoming influenced by the digital creativity which surrounds them. Our training models have to be diverse and considerate of the multiple contextual shifts with which systemic practitioners are contending, and the current context is complex for student, supervisor and families alike. The aim of this paper is to consider how digital practices might reshape our systemic training, supervision and competence evaluation, considering issues for student and trainer as they move to digital delivery of training and supervision. This paper explores the historical context of online learning, enhancing online presence, and the ethical and practical implications of teaching and supervising digitally. It concludes with a discussion about how competence frameworks are influenced by the shift to digital practice and suggests digital skills required for systemic practice going forward.Practitioner Points Consider how digital practices might reshape your systemic training delivery, with attention to enhancing online presence. Pay particular consideration in live supervision to trainee’s skills in attentiveness and attunement to family and couple interactions and emotional responses. Consider the differing processes of competence evaluation online and the need to attend to specific digital skills.

The Virtual Bug: Online Live Supervision of Telemental Health Counseling

In this article, the authors present a model for the provision of Online Live Supervision of Telemental Health Counseling (OLSTHC). The model includes its development context, logistical considerations, technology and communication needs, administrative requirements, as well as clinical recommendations. In addition, the authors address ethical, multicultural, as well as future research considerations in the implementation of OLSTHC. The authors developed this model as a response to the training disruptions brought about by the Covid-19 pandemic and it represents a feasible alternative for the implementation of a virtual counseling training clinic.

Behind the (Virtual) Mirror: Online Live Supervision in Couple and Family Therapy.

Online therapy and supervision, a rapidly rising practice in couple and family therapy, has been the subject of a growing body of literature. From its early days, family therapy training has included live supervision, which has typically been conducted by a supervisor and a team of trainees situated on the other side of a one-way mirror. With the outbreak of the COVID-19 global pandemic, we-the staff of supervisors at the Barcai Institute in Tel Aviv, Israel-were compelled to find solutions to continue meeting with clients and to provide supervision for family therapy trainees. To this end, we have shifted our live supervision courses ("practicums") to the virtual arena, adapting the popular application "Zoom" into what we call "PractiZoom." Based on over 100 PractiZoom sessions conducted between March and May 2020, involving 14 supervisors and 28 therapists-in-training and their clients, the article reflects on this pioneering online practicum for the online live supervision of therapists with geographically distributed participants. In this article, we outline our operational methods and adaptations for conducting live behind-the-mirror supervision online. Following a short theoretical background, we outline the process of online live supervision, discuss our reflections and those of our trainees on the challenges and possibilities it poses, and offer a number of preliminary conclusions and recommendations.

Building the Pyramid That Leads to Client’s Progress: Supervision, Therapists’ Work, and Client Alliance

The current study examined ifMFT live supervision, utilizing praise for effort, makes a difference in the therapist’s and client’s therapeutic alliance. Three single client cases were examined using an A-B-A phase implementation to supervision. Researchers indicated the effects of praise for effort on clients’ and therapists’ perceptions of creating a stronger therapeutic alliance. Results showed an increase in the therapeutic alliance over time as a result of the praise for effort intervention. The effect size of 102% for the client and 91% for the therapist indicated that the supervision was effective for both the client and therapist.

A Randomized Controlled Trial of Two Methods to Improve Motivational Interviewing Training

Purpose: This randomized controlled study examines the efficacy of two innovative methods to teach beginning motivational interviewing (MI) skills: live supervision (LS), a small group experiential learning interaction with standardized client actors and in-the-moment guidance from a supervisor, and a coding learning (CL) method, where students in a classroom setting are introduced to MI skill development via learning to code MI practice behaviors. Methods: Seventeen social work students in a child welfare training program were randomized to receive either LS or CL training method. Changes in MI knowledge, attitudes, and MI skill were assessed through self-report and observational measures pretraining, posttraining, and at 5 months follow-up, after a semester of learning-as-usual. Results: Both training groups demonstrated an improvement in MI knowledge and attitudes from pretest to follow-up. MI skill gain within groups varied for specific MI skills. Discussion: Implications for maximally efficient MI training are advanced.

Whatever Happened to Couples and Family Therapy in Psychiatry?

Whatever Happened to Couples and Family Therapy in Psychiatry?