How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students?

Figures & data

Figure 1 The theoretical framework of the study.

Notes: Based on data from the theory of planned behavior by Ajzen²⁵ and the social practice theory by Billet and Newton, 2010.²⁴

Table 1 Focus Area, Items and Target Constructs Derived from the Theory of Planned Behavior and Practice Theory

Focus Area	Theoretical Construct	Item
Supervising	Attitudes	At our primary care center, we set aside time to supervise medical students.
		It is important to supervise medical students at the primary care center.
	Social norm	I am expected to supervise students at the primary care center
	Perceived behavioral control (Self-efficacy)	I am sufficiently competent to supervise students at the primary care center.
	Perceived behavioral control (Controllability)	I can influence how much supervision medical students are offered at the primary care center.
	Organizational preconditions	I believe that there are organizational preconditions (time, resources) to ensure supervision of medical students at the primary care center.
	Behavioral intention	I plan to set aside additional time to supervise medical students in the future.
Supervision competence	Attitudes	At our primary care center, we regularly set aside time to develop supervision competence.
		It is important that supervisors at the primary care center can set aside time to develop supervision competence.
	Social norm	At the primary care center, I am expected to develop supervision competence.
	Perceived behavioral control (controllability)	I can develop competence in supervision if I want to.
		I can influence how the supervision competencies are used at the primary care center.
	Behavioral intention	I plan to set aside additional time to develop competence in supervision in the future.
	Structural preconditions	I believe that there are organizational preconditions (time, resources) to enable development of supervision competencies at the primary care center.

Table 2 Characteristics of the Respondents

Variable		Number
Sex	Female	130
	Male	49
	Missing	2
Age (years)	<30	5
	31–50	89
	>50	87
Work	Public	112
	Private	69
Role	Supervisor	80
	Manager	84
	Both	17

Table 3 Distribution of Answers on the Likert Scale for Supervisors (N = 95) and Managers (N = 86)

Item	Strongly Disagree N (%)		Disagree N (%)		Neither Agree Nor Disagree N (%)		Agree N (%)		Strongly Agree N (%)
	S*	M**	S*	M**	S*	M**	S*	M**	S*	M**
At our primary care center, we set aside time to supervise medical students.		1 (1.2)	3 (3.2)		3 (3.2)	5 (5.8)	29 (30.5)	17 (19.8)	60 (63.2)	63 (73.3)
It is important to supervise medical students at the primary care center.		1 (1.2)			1 (1.1)		6 (6.3)	15 (17.4)	88 (92.6)	70 (81.4)
I am expected to supervise students at the primary care center.		6 (7%)			2 (2.1)	3 (3.5)	16 (16.8)	10 (11.6)	77 (81.1)	67 (77.9)
I am sufficiently competent to supervise students at the primary care center.		34 (39.5)	1 (1.1)	5 (5.8)	2 (2.1)	26 (30.2)	28 (29.5)	12 (14)	64 (67.4)	9 (10.5)
I can influence how much supervision medical students are offered at the primary care center.	6 (6.3)	3 (3.5)	5 (5.3)	3 (3.5)	15 (15.8)	7 (8.1)	39 (41.1)	32 (37.2)	30 (31.6)	41 (47.7)
I believe that there are organizational preconditions (time, resources) to ensure supervision of medical students at the primary care center.	3 (3.2)	1 (1.2)	3 (3.2)	8 (9.3)	13 (16.8)	9 (10.5)	46 (48.4)	34 (39.5)	27 (28.4)	34 (39.5)
I plan to set aside additional time to supervise medical students in the future”.	12 (12.6)	13 (13.1)	5 (5.3)	3 (3.5)	50 (52.6)	50 (58.1)	18 (18.9)	13 (15.1)	10 (10.5)	7 (8.1)
At our primary care center, we regularly set aside time to develop supervision competence.	6 (6.3)	4 (4.7)	16 (16.8)	8 (9.3)	21 (22.1)	18 (20.9)	31 (32.6)	24 (27.9)	21 21.1)	32 (37.2)
It is important that supervisors at the primary care center can set aside time to develop supervision competence.		1 (1.2)	1 (1.1)		3 (3.2)	4 (4.7)	37 (38.9)	32 (37.2)	54 (56.8)	49 (57)
At the primary care center, I am expected to develop supervision competence.	5 (5.3)	11 (12.8)	17 (17.9)	4 (4.7)	19 (20)	21 (24.4)	31 (32.6)	23 (26.7)	23 (24.2)	27 (31.4)
I can develop competence in supervision if I want to.		4 (4.7)	5 (5.3)	5 (5.8)	23 (24.2)	27 (31.4)	39 (41.1)	28 (32.6)	28 (29.5)	22 (22.6)
I can influence how the supervision competencies are used at the primary care center.	3 (3.2)	2 (2.3)	4 (4.2)	2 (2.3)	27 (28.4)	12 (14)	38 (40.0)	31 (36.0)	23 (24.2)	39 (45.3)
I plan to set aside additional time to develop competence in supervision in the future.	8 (8.4)	8 (9.3)	9 (9.5)	4 (4.7)	46 (48.4)	56 (65.1)	24 (23.5)	14 (16.3)	8 (8.4)	4 (4.7)
I believe that there are organizational preconditions (time, resources) to enable development of supervision competencies at the primary care center.	6 (6.3)	2 (2.3)	11 (11.6)	7 (8.1)	22 (23.2)	19 (22.1)	40 (42.1)	32 (37.2)	16 (16.8)	26 (30.2)

Notes: *supervisors, **managers.

Table 4 Themes and Categories Emerged from the Content Analysis of the Open-Ended Question: ”Give Examples of Support/Resources You Need to Improve the Clinical Supervision and Learning Environment of Medical Students at the Primary Care Center”

Theme	Category
Time and distribution	Scheduled time for supervision
	Distribute time for supervision among all colleagues
	More colleagues that can take on supervision (a shortage of staff in general)
	Make feasible for some, specifically interested colleagues to focus on enhancing supervision skills to help build collective competence at the PHCC
Improved communication and support systems	Scheduled regular meetings between the clinical supervisors and PHCC managers concerning supervision of students
	Incentives for attendance at meetings
	Increased regular communication between medical school and the PHCC
	Regular meetings between PHCC supervisors and faculty
	Medical school support for improving supervision skills and building of collective supervision competence
	Feasible on-site educational activities
	Online educational activities and resources
	Individual and collective incentives for supervising and for developing supervision competence
Elimination of structural barriers	Improve living conditions for students at remote placements.
	Increased and appropriate space and resources to enable high quality supervision in PHCC
	Alternative employment arrangements for physicians who wish to engage more in teaching and supervision
	Supervision as a part of measures taken to make the PHCC an attractive workplace – a good learning environment as a recruitment strategy
	Clarity concerning existing reimbursement to the PHCC for supervision and production loss
	Realistic financial support to PHCC
	System incentives for supervision of all categories of learners – mandatory reports of education production as well as care production.

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