title: Supervisor continuity or co-location: which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada.
abstract: OBJECTIVE
  Changes to health care systems and working hours have fragmented residents' clinical experiences with potentially negative effects on their development as professionals. Investigation of off-site supervision, which has been implemented in isolated rural practice, could reveal important but less overt components of residency education.
  
  
  METHODS
  Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision.
  
  
  RESULTS
  Thirteen Australian family physicians from five states and one territory, and three Canadians from one province, participated. The main themes were how remoteness changed the dynamics of care and supervision; the importance of ongoing, holistic, nonhierarchical, supportive supervisory relationships; and that residents learned "clinical courage" through responsibility for patients' care over time. Distance required supervisors to articulate and pass on their expertise to residents but made monitoring difficult. Supervisory continuity encouraged residents to build on past experiences and confront deficiencies.
  
  
  CONCLUSIONS
  Remote supervision enabled residents to develop as clinicians and professionals. This questions the supremacy of co-location as an organizing principle for residency education. Future specialists may benefit from programs that give them ongoing and increasing responsibility for a group of patients and supportive continuity of supervision as residents.
authors.affiliation: Dr. Wearne is a family physician, Alice Springs and Yulara, Northern Territory, Australia, and Supervisor Research and Development Adviser, General Practice Education and Training, Canberra, Australian Capital Territories, Australia. Dr. Dornan is professor of medical education, Maastricht University, Maastricht, the Netherlands. Dr. Teunissen is associate professor, Maastricht University, Maastricht, the Netherlands, and resident in obstetrics and gynecology, Free University Medical Centre, Amsterdam, the Netherlands. Dr. Skinner is a health psychologist and head, School of Psychology and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Wearne
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.forename: Timothy
authors.initials: T
authors.lastname: Skinner
mesh_terms: D001315:Australia; D002170:Canada; D007396:Internship and Residency / Q000379:methods*; D009934:Organization and Administration; D010821:Physicians, Family; D019035:Rural Health Services