Should supervision be a part of continuing professional development for GPs? The Danish experience would suggest it should

The external pressure on general practitioners (GPs) has been raised with higher workload, consumerism and a low threshold for litigation. In daily work GPs deal with a wide variety of problems, having many personal contacts each day not only with healthy people but also with patients having severe illnesses or traumatised souls. Bearing in mind the need to retain and recruit more GPs, this increasing burden might indicate a need for organised support in form of peer groups to support the profession. The concept of supervision is used in many contexts such as mentoring, coaching, and clinical supervision during underand postgraduate medical education as well as the educational supervision of researchers studying for doctorates. The concept of clinical supervision in healthcare is not clearly defined, although many of the helping professions now have an established culture of clinical supervision not only for trainees but as ongoing activities in professional life. To date, this has not permeated general practice widely. The word supervision is ambiguous: the literal meaning of overseeing can carry overtones of being controlled. Control may be part of supervision especially in training, where it may be the way for the profession to gate-keep. Qualified GPs, who not infrequently have chosen this branch of the medical profession because of the relative autonomy compared to hospital medicine, are not keen on more control of their professional activity. Good non-managerial supervision, however, does not stress the control element, and places the emphasis on ways of facilitating reflection in a world full of continuous decision making. Supervision in general practice usefully looks at how to develop competencies, how to establish and maintain the GP’s role as a professional, increasing personal and professional awareness, and support throughout professional life. In Denmark accreditation of GPs has not been introduced. The individual doctor retains responsibility for securing continuing medical education (CME), and for maintaining and improving clinical performance. A great part of CME is small group based. Eighty percent of Danish GPs belong to a CME group. Since the mid-1990s supervision groups have existed as part of CME and are in most regions subsidised as CME activities by a national fund, whereas some regions have special agreements for supervision groups which are partially subsidised by the Quality Assurance bodies for general practice. Whether the groups function as ordinary CME groups or supervision groups, they have to choose a group leader but are otherwise totally self-directed. If the group choose to work as a supervision group, the members choose their supervisor themselves among qualified supervisors. Participating in CME groups or supervision groups has been shown to play a role in preventing burnout among doctors. Tulinius and HølgeHazelton show in their study that GPs prefer group supervision for other educational activities. About one-third of Danish GPs join an ongoing supervision group (survey 2008 not published). Group supervision is a structured educational activity with a qualified supervisor, which takes its point of departure from the problems experienced in professional work. Theoretically it combines adult learning theory with psychological theories. Mostly it is characterised by ongoing groups with high commitment, regular meetings, and defined boundaries for the work to be done. In peer supervision groups GPs trained to be group leaders or facilitators may take on the role of the supervisor in turn. Internationally, the most common literature on supervision groups for GPs concerns Balint groups, which were originally developed for the GPs to increase awareness of psychological dimensions in the daily consultations. The first supervision groups in Denmark in the 1960s and 1970s were Balint groups or Bendix groups, named after a Danish psychiatrist who was committed to teaching GPs therapeutic skills. Education for Primary Care (2011) 22: 216–18 # 2011 Radcliffe Publishing Limited