By: Severin Pinilla, MD M.Ed. PhD
As a psychiatrist/psychotherapist and educator, I regularly struggle with the concepts of ‘supervision’ and ‘coaching’ as used in the health profession education literature and practice. I was, for example, quite surprised to learn in an AMEE conference workshop that in some faculty development programs clinicians can become ‘coaches’ within a half-day workshop in contrast to sometimes yearlong coaching and supervision trainings in other programs. The figure from Hawkins et al. (2020) depicts the main dimensions that need to be watched out for in supervision. I would argue that while in clinical supervision we might often be limited in terms of time and content of supervision and coaching, we have to consider all these dimensions when dealing with more complex clinical situations or aiming for personal growth of trainees and supervisors.
In competency-based medical and psychotherapy education, effective feedback and supervision are pivotal in fostering professional growth. Both fields rely on structured coaching or supervision frameworks and models to help trainees become competent (1, 2, 3, 4). These models emphasize a reflective, learner-centered approach, underscoring the need for intentional coaching and supervision skills.
Clinical coaching however is more than delivering feedback – it is about fostering meaningful conversations that enable behavioral change. Models such as the four-phase R2C2 framework (Relationship, Reaction, Content, and Coaching) point toward the layered complexity of such interactions. While building rapport and exploring reactions appears to be easier to apply consistently for novice coach-trainee dyads, they seem to struggle more with creating actionable plans and ensuring follow-up (1).
This finding points to a potentially critical faculty development gap: coaching is not an innate or easy to learn technical skill for a short session but requires deliberate practice and solid coaching competence. Experiential learning, including simulated feedback scenarios and active experimentation with coaching might be as vital for equipping clinician-educators with these skills as for psychotherapeutic supervisors. Without sufficient training, the cognitive load of integrating coaching strategies in real-time becomes overwhelming, potentially leading to inconsistent application and ultimately ineffective and frustrating coaching experiences.
Similarly supervision in psychotherapy training relies on theory-informed and structured approaches to navigate complex interpersonal dynamics. The supervision model of Lieb (3) for example distinguishes between focus on a primary psychotherapeutic trajectory and secondary ‘supervision modules’ addressing specific challenges of trainees, such as therapist-patient interactions, supervisor-trainee interactions, specific clinical teaching and instruction or context analysis. This differentiation allows supervisors to structure sessions and identify and address emerging issues without derailing the main focus of supervision.
Effective supervision and coaching therefore not only supports trainees in resolving immediate clinical concerns but also encourages self-reflection and professional identity formation. Supervisors facilitate the exploration of trainees’ personal biases or emotional responses, which can impact the therapeutic process. This reflective component is particularly important, as it promotes a deeper understanding of interpersonal dynamics and fosters resilience in handling challenging cases.
One significant barrier to effective coaching lies in oversimplifying techniques and overlooking the deeper, reflective aspects of the coach’s role and interpersonal dynamics. When coaching training focus solely on procedural aspects without delving into the coach’s biases, interpersonal processes, and worldviews, it risks losing authenticity and nuance in coaching interactions. These unexamined factors can unconsciously shape the feedback process, potentially introducing unhelpful dynamics into the learner-coach relationship. Competency-based training depends on tailoring coaching to individual needs, and failing to reflect on the coach’s internal influences may undermine its effectiveness. Therefore, fostering self-awareness in coaches is essential for delivering impactful and equitable coaching interventions.
Both clinical coaching and psychotherapy supervision thus reveal a shared challenge: the need for substantial training to be able to effectively help learners in their professional development. Insights from supervision research in psychotherapy could inform faculty development initiatives in competency-based medical education and vice versa.
By examining these parallels, it becomes evident that robust coaching and supervision require more than procedural knowledge – they demand continuous personal growth and reflective practice. In the end it might not be so much the conceptual framework educators and trainees (e.g. mentoring, coaching or supervision) work within but the quality, depth and breadth of the learning interaction between them. As institutions seek to enhance their faculty development and effectively implement competency-based education, how might they integrate these aspects to empower educators and supervisors?
About the Author:
Severin Pinilla, MD M.Ed. PhD, is an attending physician and research fellow at University Hospital of Old Age Psychiatry and Psychotherapy Bern, Switzerland. His research focuses on different aspects of competency-based medical education, entrustable professional activities and teaching and learning in psychiatry.
References
- Lockyer, J., Lee-Krueger, R., Armson, H., Hanmore, T., Koltz, E., Könings, K., … & Sargeant, J. (2023). Application of the R2C2 model to in-the-moment feedback and coaching. Academic Medicine, 98(9), 1062-1068.
- Ramani, S., Kusurkar, R. A., Lyon-Maris, J., Pyörälä, E., Rogers, G. D., Samarasekera, D. D., … & Ten Cate, O. (2024). Mentorship in health professions education–an AMEE guide for mentors and mentees: AMEE Guide No. 167. Medical teacher, 46(8), 999-1011.
- Lieb, H. (2005). Verhaltenstherapeutische Supervision–Ein Modell in Haupt-und Unterprogrammen. [engl.: Cognitive-behavioural supervision – A model in Main and subprogrammes] Verhaltenstherapie & Psychosoziale Praxis, 3, 483-496.
- Hawkins, P., & McMahon, A. (2020). Supervision in the helping professions (5th ed.). London: Open University Press.
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