Key Messages
Supervisors assign services to students and support workers. When supervising physiotherapist interns, their job shifts to an oversight role where they ensure the intern is working within their competence.
The onboarding checklist for supervising physiotherapist interns can be used to support a smooth start to a new supervisee-supervisor relationship.
The competencies of the supervisor and supervisee must align for the supervision relationship to work. Supervisors can’t supervise services that they themselves are not competent to provide.
As the College of Physiotherapists of Alberta updated the Standards of Practice, there were several changes made to the Supervision Standard of Practice. One significant change was the explicit recognition that different supervisee groups have different supervision requirements due to their education and registration status. This article focuses on the supervision of physiotherapist interns.
Identifying Supervisory Roles
One of the main changes made was recognition that the supervisor’s role when supervising a physiotherapist intern is to provide oversight and ensure appropriate physiotherapy service provision, with the physiotherapist intern being responsible for the care they deliver. This differs from the type of assignment required when working with physiotherapy students or physiotherapist support workers.
It is helpful to break down the roles that the supervising physiotherapist and the physiotherapist intern play in the supervisory relationship.
Role of the supervisor:
- Assesses the knowledge, skills, and judgment of physiotherapist interns.
- Ensures that the physiotherapist intern performs only those activities that the physiotherapist intern is competent to perform.
- Ensures that the physiotherapist intern performs only those activities that the supervisor is competent to perform and supervise.
- Monitors the quality of the services provided and the documentation completed.
- Employs direct or indirect supervision strategies appropriate to the competence of the physiotherapist intern, the client’s care needs, identified risks, and other factors related to the practice environment.
- Establishes ongoing communication processes with physiotherapist interns.
- Complies with legislative and regulatory rules regarding performance and supervision of restricted activities by physiotherapist interns.
It is the physiotherapist intern’s responsibility to accept accountability for the care they deliver and to recognize when they are struggling to provide safe, effective care. They must identify when it is appropriate to stop or pause care to consult with or work with the supervisor.
Role of the supervisee:
- Accept accountability to deliver safe, effective, quality care that is within your current level of knowledge and skill
- Identify when the type of care you are required to deliver exceeds your current capabilities
- Take appropriate action when situations arise that exceed your current level of competence
Onboarding Checklist
This checklist will provide some key pieces of where to start with your supervisor/supervisee relationship.
- Signed supervision agreement
- Supervisee has completed registration
- Supervisor verified supervisee’s registration via Verify a PT
- Discussed plan for initial period of direct supervision
What the College Requires
Below is a checklist that supervisors can start on the first day of supervision.
- Identify current competencies by assessing the physiotherapist intern’s knowledge skills and judgment
- Competencies that are shared
- Competencies the physiotherapist intern is lacking
- Competencies the physiotherapist intern has but the supervising physiotherapist does not (This is important because the physiotherapist cannot supervise the physiotherapist intern in any activities that the physiotherapist does not have the competence to do so themselves)
- Review supervision requirements for any applicable restricted activities
- Review the need for direct supervision and discuss the plan to transition to indirect supervision when appropriate
The change of wording from the supervisor “assigning” services to instead “ensuring” the physiotherapist intern only provides those services they are competent to provide does not change the requirement to assess what the physiotherapist intern is competent or not competent to do in your practice setting.
Enhancing the Supervisory Relationship
We have covered the regulatory expectations when it comes to supervising physiotherapist interns, but it is also important to recognize that successful supervisory relationships are built on communication and setting realistic expectations. You can review this article to discover how to make the most of the supervisory relationship. This section will cover some of the things you should be discussing at the start of this process.
- Discuss methods of communication and feedback that will work for both parties
- Reinforce that all questions are good questions
- Identify and plan for strengths and weaknesses of both parties
- Identify goals for future skill development for the physiotherapist intern
- Identify strategies for the physiotherapist intern to achieve these goals through courses or with supervised practice and assistance from the PT supervisor or another PT if necessary
Plan the Transition from Direct Supervision to Indirect Supervision
Every supervisory relationship starts with a period of direct supervision. As the supervisor, you assess what the physiotherapist intern is competent to perform and where they need further development. To do so effectively, you need to be present to evaluate their skill sets. The overarching goal is to establish that the supervisee can provide safe, effective, quality care with supervision.
As a supervisor, you need to use your professional judgment to decide how to transition away from direct supervision and move to a more indirect supervision model. There are many factors that will contribute to what this looks like in practice, but you should consider the competence of the physiotherapist intern in both their technical and non-technical skill sets. The practice site can alter what this looks like as there are a variety of differences between long-term care, and ICU, pediatrics, or orthopedics. Risk factors and competence to perform the skills required to assess and treat clients safely should be foremost in your decision making when transitioning from direct to indirect supervision.
As the physiotherapist intern improves in their competencies you can start to transition to more indirect supervision. This transition is usually gradual over time. It is still normal for a physiotherapist intern at three months into the supervisory relationship to come across something they haven’t seen before or are unsure of and you might be back into doing a bit of direct supervision to help them through it.
Reminder About Physiotherapist Interns and Restricted Activities
If performance of restricted activities is part of the physiotherapist intern’s practice within your setting (e.g., suctioning, wound debridement and care), direct supervision requirements will remain in place when the physiotherapist intern is performing the restricted activity, this will affect the ability to transition from direct to indirect supervision in a general sense.
Supervision Requirements are Ongoing
Supervision must continue until the physiotherapist intern is on the General Register. This does not necessarily mean that you are next to them in the treatment room for all that time, but you must provide supervision throughout this timeframe. You could maintain your supervision requirements using indirect methods, by meeting regularly for chart audits, arranging dedicated one-on-one time, and being available for questions they might have during their workday.
With the requirement for supervision to continue until the physiotherapist intern is admitted to the General Register, you should take the time to consider if you are able to meet the expectations found in the Standard of Practice and are able to provide the supervision necessary to ensure quality, safe, and effective care is being delivered. There can be situations where supervisors feel pressure from ownership or management, financial pressures, and demands on their time which could make supervision challenging. Remember that it is OK to share supervision responsibilities with another physiotherapist on the General Register and that if you find yourself in a situation where you can’t continue to provide supervision that meets the requirements of the standard, you can step down from the role, notifying the College if you do so.
There are many ways to meet the Standard’s expectations and provide appropriate supervision and oversight to the physiotherapist intern but it will require some thought on your part and potentially working with your practice site to come up with solutions.
Supervision is an ongoing process that can be quite fluid in the style and type of supervision. The physiotherapist and physiotherapist intern should be working together to deliver quality safe and effective care to the clients in their care. The College of Physiotherapists of Alberta has created several resources to help you with your role as a supervisor as it is an integral part of creating a healthy and sustainable physiotherapist workforce.
Resources
Supervision Standards of Practice
Good Practice: How To Make The Most of the Supervisory Relationship
College Conversations Podcast: Episode 18 - PT Interns
College Conversations Podcast: Episode 6 - Supervising Physiotherapy Interns
College Conversations Podcast: Episode 41 - FAQs About Supervising Physiotherapist Interns
Sean FitzGerald, PT, Practice Advisor
