La supervision clinique au Collège d'Études Ostéopathiques de Montréal

This study aims to give a better understanding to the role of the supervisor at the external clinic of the College d’Etudes Osteopathiques de Montreal (C.E.O.M). It is the result of 4 years of studies at the University of Montreal to obtain a Masters in general education. It’s a qualitative research of a research-action type, where the researcher intervention is directly in the clinic. Osteopathy is a natural medicine that has been around for 150 years and is about to get recognized in Quebec. The professional board of Quebec has been working for the last two years in elaborating the laws that will guide osteopathy. At this moment the course is given by private schools with different programs. The C.E.O.M. has been working for the last 15 years to put in place a program with university standards. With the collaboration of the university of Wales, a bachelor program was put in place. This program is of a three years duration based on a clinical education. It concerns the 3rd year students till they finish their 5th year. Which after they undergo another cycle to get their osteopathy diploma. It’s within this clinic that the research took place. The researcher, whom has been a supervisor for the last 10 years, had a background of psychopedagogy and andragogy from the university of Montreal. His work with students at the clinic who experienced difficulties pushed him to go further with his readings about clinical education, competency approach, the expert clinician and the relational abilities. His questioning about how to get the students at their full human potential, has gone to, how to define the role of the supervisor. This why, at the autumn of 2016, she proposed to her colleagues a workshop on the practical teaching in the external clinic for about three hours. To reach the maximum of participants, six presentations took place and thirty-seven supervisors took it. During this workshop, concepts taken from university curriculums as well as relational concept were presented. Since the school doesn’t have a teacher-training program, the researcher wanted to bring his contribution to the field. The themes covered were in relation with learning difficulties, motivation, stress, the role of the supervisor, where the student stands, the relationship model, relational ethics, the process of dynamic transformation towards a professional identity. Following these presentations, an invitation to participate to the research was sent out as well as a questionnaire to collect the data. Twelve people responded to the first questionnaire, where they exposed personal data, their conception to the role of the osteopath, the challenges to overcome and the resources they have. A selection with a reasoning choice was done from those volunteers in order to keep who represent the most diversity: two very experienced osteopaths but fairly new as supervisors, two well experienced supervisors that didn’t go through the clinical program, and four osteopaths that took the clinical teaching. Those 8 participants were met individually to elaborate more on their conception of the role of the supervisor. A journal was given to them so they can write down and relate the experiences they find significant through out the academic year. Then a group meeting was organized in 2017. Six were able to attend. They shared their experiences and the difficulties met during the clinic as well suggested solutions. In January 2017, a particular event rocked the college. In the process of recognition, three complaints were deposited against the clinic, for illegal practice of reserved acts. The college des Medecins, the physiotherapists order as well the chiropractionners order were suing the C.E.O.M. These complaints shocked the osteopathic community especially at the clinic of the school because three students and two supervisors were directly concerned with these complaints. The school board intervened several times to reassure, inform and support the students and the supervisors. This had an impact on the research giving the fact that less people were willing to participate. In the spring a final questionnaire was send out to the people who participated in the initial workshop. Nine responded sharing their vision on what could be a better service at the clinic. Finally, five participants gave back their journals at spring of 2017, at the end of the academic year. This research-action is based on the exchange permitting the evolution of the understanding, here the role of the supervisor at the clinic of the C.E.O.M. The participants are implicated in finding a solution to a group questioning. The body of the data is formed from initial and final questionnaires, verbatim, personal and group interview, as well as journal. It was analyzed with codes depending on different programs (Word, Excel, QDA Miner). The accuracy of the coding was maintained by the stability of the programs. The coding was done several times. The precision of the conclusions taken from the data was done taking into consideration the different types of interrogation. The analysis of the data led to the understanding of the evolution of the concepts of the participants as to their role as supervisors. At first, the define it in three categories: 1. Guide, accompany, validate 2. Listen, reassure, help 3. Share, advise, encourage At the end of the research, their vision expanded with complementary aspects: 1. Recognize the speed of learning, share his experience, validate palpation, help to develop an evaluation routine 2. Generate confidence (take the time, acknowledge his strength, find his own solutions, reassure, express his needs, valorize) 3. Practice presenting hypothesis, to question, adapt the intervention, offer feedback, define the objectives in line with the need, combine the forces, work as a team 4. The challenges met depended on the student behavior, the supervisor characteristics and the clinic context 5. The qualities of the supervisor are his knowledge and abilities, his relational skills, his capacity of adaptation, his experience or his growth The participants observed changes in the clinic due to the research. This collective work on the role of the supervisor offered a better comprehension of their role, improved a pedagogic relation more centered on the student, a better overlooking in their exchange of the student and with the student. They saw a better cohesion within the group with the use of a common vocabulary and a better mutual appreciation. They feel they are more on path of growth in their learning of a supervisor. They participated in the elaboration of recommendations on improvements that can be brought to the clinic and to the school. At the level of organizing the clinic, several points were mentioned: homogenize the group of students, simplify the retroaction forms, verify the interest in changing the supervisors, the idea of establishing a summer clinic, finalize a referential of competences for students by levels. The participants appreciated the meetings and the cohesion phenomenon within the group that resulted. They wish to pursue on that path and want more venues to exchange, to share to learn. They want to deepen their understanding of the relational model and would need examples, role-plays, documents, to experiment it and get feedback from the students and their colleagues. For the college, recommendations were suggested: establish the presence of an assistant that can follow a class through the whole year so they can become a person of resource, respect and valorize the work of the supervisor, have access to different course, improve the services to the patients. Finally the need of a course stays the priority and the researcher will pursue his work to elaborate a course for the supervisors. If osteopathy is in recognition process, the curriculum of osteopath in Quebec is not yet clearly defined. Research in the field of teaching in osteopathy, and the teaching of clinical osteopathy is at its beginning. All is still to be discovered and put to work.

Keyphrases: Clinical teaching, Clinical supervision, Supervisor, To accompany, Relational skills, Manual medecine, Osteopathy, Education - Educational psychology, Professionalism, Learning by competences, Development of professional identity