The first content element and supervisory competence in this review concerns assessment and the ways in which explicit knowledge of assessment could impact the vocational training for the supervisee. Assessment refers to the process of evaluating the extent to which a supervisee has reached the goals that exist for a professional education. Participants in supervisor training reported increased confidence in supervision knowledge and skills and development of a robust competence to examine participants’ learning (Attrill et al., 2020).

However, supervisors also reported the need to have enough contact with the supervisees in order to accurately assess their competences; otherwise, it was difficult to recognise and deal with failing supervisees (Kellett et al., 2015). Govaerts et al. (2017) stress the importance of supervisors discussing the assignment decisions and the training objectives and providing feedback to trainee supervisors. Communication increases supervisees’ motivation to participate in training courses as well as enhance the transfer of the training into practice.

DiMino and Risler (2012, 2014) recommend including expert supervisors (that is, experienced supervisors) in supervisor training programmes (see also Kemer et al., 2014). Thus, supervision educators, such as experienced experts, can help supervisors-to-be to build on their conceptualisation skills for conducting comprehensive assessments of their supervisees, including supervisee assessment, supervisory relationship and supervisor self-assessment (Kemer et al., 2014). Dijksterhuis et al. (2009) explored supervisors’ and supervisees’ approaches to assessment and found, from focus group interviews, that assessment is twofold: on the one hand, there is a need to assess the supervisees’ competences within the professional area; on the other, there is a need to progressively evaluate independence. It is important to avoid paternalism, whereby the supervision continues throughout the training without allowing the supervisee to develop independence. Access to the supervisee’s competence can be gained through means such as direct observation, discussions with other staff members or self-assessment by the supervisee connected to previous experience. Dijksterhuis et al. (2009) propose a model that distinguishes between the levels of novice, advanced beginner, competency, proficiency and expert, in giving structure to the process of determining whether the supervisee is sufficiently competent (Dijksterhuis et al., 2009). Kilminster et al. (2007) recommend keeping records of assessments through the use of logbooks.

Durguerian et al. (2000) identify areas in which supervision assessment training is needed. These include helping the supervisee to conduct self-assessment and confirming the completion of the training agreement. Sagasser et al. (2015) claim that self-regulated learning is essential for professional development and lifelong learning. Self-regulated learning is a way to get the supervisee to develop independence in the assessment of goal attainment. Sagasser et al. (2015) argue that supervisor training must include awareness of supervisors’ beliefs about their role and the role of the supervisee. Ybrandt and Armelius’s (2009) main finding is that the supervisor trainees’ self-image after training became freer and more autonomous. Autonomy training, empowering the supervisee and helping the supervisee to develop their own solutions seem to be relevant components in supervisor training for all professionals across subjects (Kilminster et al., 2007). Supervisees requested more hands-on learning and less observing (Daugherty, 2011). Several other studies have highlighted the issues of autonomy and self-assessment. Sturman et al. (2020) argue that supervisors need to encourage progressive trainee autonomy and boost supervisees’ self-entrustment and self-assessment.

Kellett et al. (2015) and Mahasneh et al. (2020) also discuss the importance of supporting supervisee confidence and giving enough responsibility in practical training situations. Self-doubt and anxiety need to be replaced by increased confidence, based on self-observation and self-assessment in supervisor training, resulting in feelings of being effective and in control (De Stefano et al., 2014). The self-assessment and self-reflection can be documented through supervisors being encouraged to articulate a personal philosophy of supervising, based on statements of teaching and learning theories.

The above studies related to assessment stress the importance of having enough time to supervise and being present, providing clear assignments, giving feedback, conducting self-assessment, and the benefits of trained and experienced supervisors. Although the content element of assessment received the most hits in this review, there is still a lack of research regarding factors such as goal setting and assessment, and supervisees’ perspective on assessment. The field of assessment is also comprehensive in other learning settings and how understanding from related fields could enrich supervision training.

The second content element refers to communication. According to Blackman and Schmidt’s (2013) focus group interviews with supervisors, communication was considered to be the most important supervisory skill. Ögren and Sundin (2009) also identified important gains when focusing on communication. They explored small-group supervision and found that working climate improved over time. A more flexible and collaborative style of interaction was increasingly used. One important aspect for improvement was that communication became more flexible in the group. To strengthen the competence of communication, Chen and Liu (2019) suggest using video as a teaching tool for practical training and analysing interpersonal interactions. Recordings enable possible reflective conversations and feedback around matters such as how supervisors express themselves and their tone of voice. Chen and Liu (2019) argue that integrating communication skills in supervisor training also decreases the risk of abusive supervision.

Kellett et al. (2015) have considered communication in more detail and highlighted the need for increased team-working skills, such as advanced communication and negotiation skills. This includes communicating with senior colleagues and with patients around complex issues and dealing with challenging team members. In addition, Oerlemans et al. (2017) emphasise the development of communicating competences, specifically in doctor–patient interactions. In Daugherty (2011), supervisees requested more one-on-one contact with the site supervisor, and for supervisors to talk to students in more detail about their jobs. Inman et al. (2019) highlight the challenge of supervision online, and most of the participants in that study highly valued the quality of face-to-face supervision compared to tele-supervision.

Several studies have connected the aspect of communication to both the assessment and feedback aspects. For example, Loureiro et al. (2015) stress the importance of learning about communication through different assessment and feedback methodologies.

Furthermore, Kilminster et al. (2007) suggest giving and receiving feedback in connection with training communication skills. Similarly, supervisors need to organise training programmes in a safe learning environment that allows constructive criticism of their training, including the supervision process (Kilminster et al., 2007). Menefee et al. (2014) connect adaptive strategies to supervision, as these may establish a relationship between supervisor and supervisee. The authors conclude that supervisees who use avoidant strategies with their supervisors may be less likely to address future conflicts.

The central message that appeared in connection to communication is the value of clarifying both clear and challenging learning objectives that relate to prompt and specific feedback (Marton and Morris, 2002). Practical training in giving and receiving feedback is encouraged, but there seems to be a lack of studies investigating how training of communication skills affect the supervision.

Oerlemans et al. (2017) discuss a conceptual framework that distinguishes between desirable and undesirable narrative profiles in connection to a doctor–patient relation. Similarly, a discussion about different stereotypes and supervision profiles should be relevant in all supervision training courses. Oerlemans et al. (2017) mention the cultural background of trainees as an example of a personal value that can negatively influence the doctor–patient interaction, causing trainees to underperform. In the same way, it is relevant for supervisors, during their training courses, to reflect on ethical questions in connection to desirable and undesirable supervision behaviour. Daugherty (2011) presents and develops the qualities of a good intern relative to a poor one, as well as the traits of a good or poor supervisor, noting that one of the supervisors’ greatest fears and anxieties was getting a supervisee with a poor work ethic. This conforms to reflection: how can supervisors be trained to foster ethical supervisee behaviour?

Furthermore, Fall and Sutton (2004) discuss the concept of personal awareness. The percentage of time spent on personal awareness function (approximately 25 per cent) reported by supervisors was less than expected. Consequently, it seems reasonable to combine discussions around ethics and personal awareness in supervision training courses. Flanagan and Grehan (2011) show that a vital competence for supervisors is ethical decision-making in goal setting and in the supervisor–supervisee relation. Developing a good-quality supervisory relationship is crucial, and both personal and professional characteristics are central (Bucky et al., 2010).

In sum, it is important to discuss cultural background in connection with desirable and undesirable supervision behaviour. Additionally, goal setting and the supervisor–supervisee relation are also crucial when it comes to discussing personal awareness around ethics, but guidelines for this seem to be lacking. However, the literature on ethics in supervision was found to a low extent in this study. Delivering feedback is a fundamental component in supervision, and this is discussed below.

The fourth aspect discussed in this review deals with feedback. Thrasher et al. (2016) highlight that supervisees expect their supervisors to provide support through guidance and feedback, teaching new skills and initiating contact with them. In addition, supervisees make a connection between receiving feedback and developing confidence to perform practical tasks independently (Kellett et al., 2015). As supervisees often request immediate feedback and dialogue with the assessor (Ringsted et al., 2004), supervisors need to organise teaching and learning situations that enable direct response and comments in a situation. However, giving feedback could be considered as a competence to develop. Donaghue (2020) explores how feedback meetings in supervision settings may impact identities of experiences and influence teacher development. Her findings suggest that feedback was mainly evaluative, despite explicit demands for development and formative feedback. Thus, there is a risk that this approach counteracts goals of improved learning, and Donaghue (2020) promotes increased supervisory education related to feedback. Positive feedback and regular meetings are considered key to supporting good supervision (Kilminster and Jolly, 2000; Kilminster et al., 2007).

According to Blackman and Schmidt (2013), practical training could support the development of giving feedback. Participants in supervision training courses valued activities highly when acting as a supervisor and having supervisory role models. Based on focus group interviews with supervisors, Blackman and Schmidt (2013) find that participants emphasised the competence of providing relevant feedback, and also being able to communicate the feedback. Sagasser et al. (2015) suggest that sharing and receiving feedback in collaborative groups may encourage critical self-reflection around one’s own part in supervision. Bennett and Lehman (2002) also suggest role playing for the training of giving feedback. In their study, role playing was practised as a way to encourage seeking and giving help in the supervisor relationship.

Moreover, it is useful during supervisor training to reflect on what role the supervisors play in providing feedback; the supervisee’s role as a manager, communicator, collaborator and so on; and whether the feedback focuses mostly on strengths or improvement points (Renting et al., 2016). Kilminster et al. (2007) present notions related to concrete feedback and recommendations, supporting strengths and weaknesses and suggesting ways to improve them, timely feedback close to the event, allowing the supervisee to start reflecting on their performance, and identifying areas of difficulty and possibilities for change, starting with positive aspects, and being specific and descriptive. Failure to address underperformance and lack of commitment to supervision were identified as factors that made supervision difficult (Kilminster et al., 2007).

The importance of receiving feedback has been well documented. In summary, the reviewed studies suggest that supervisors need to consider who initiates the occasion for feedback, supporting the supervisees’ confidence, starting in a positive manner, offering regular meetings and immediate feedback, addressing underperformance and pinpointing what can be improved and proposing practical training and role playing with concrete feedback. Furthermore, the studies discuss how and when to give feedback, although the content of the feedback is more seldom highlighted.

The final reviewed content element in supervision training courses concerns learning and supervision theories. Several studies have discussed the importance of having theoretical approaches to supervision and accessing tools for handling different kinds of supervision situations. Sahin et al. (2011) argue that it is reasonable to expect the inclusion of theories on effective teaching and learning in supervision and that these theories are problematised and discussed in connection to different subjects. The authors conclude that supervisor course participants want to learn about useful supervisory methods, and that participating in supervisor training is about learning how the individual can be his or her best professional self.

Wambu and Myers (2019) present a study in which participants expressed a need for support and collaboration with university supervisors, thereby stressing the importance of connecting theory with practice. Furthermore, Nel et al. (2012) emphasise the relation between theory and practice by asking qualified clinical psychologists which of the learning activities they encountered during their training best prepared them for post-qualification practice. The answers emphasised the importance of theories on learning through doing, combined with observational learning and problem-based learning. Nel et al. (2012) argue that planning future supervision training should take the results of theories on learning by doing and observing into account. Furthermore, practitioners should ask how they can support supervision learning activity, as well as opportunities for observing competent and experienced supervisors in action.

Kilminster et al. (2007) claim that there are no perfect or complete theoretical accounts of supervision in medicine. However, they also suggest that adult learning theories, experiential and work-based learning, as well as understandings about apprenticeship and development of expertise, are possible supervision theories and could be used for exploring supervision situations. According to Atieno Okech and Rubel (2009), most models of supervision pertain to supervision of individual counselling, and this tradition might also influence how supervision training is organised, although it is habitually organised in groups of post-degree supervisors-to-be. Rees et al. (2019) also suggest that a mixed pedagogical approach has numerous positive outcomes. This means that supervision training interventions may impact social learning and protected time for supervisors. The suggestions to use different forms of pedagogical theory, learn from each other, and reserve time for supervision are in line with previous research (for example, Davidsson and Stigmar, 2021) on the benefits of supervisory outcomes from training programmes.

Although Kilminster et al. (2007) and others argue for a mixed theoretical approach, Nelson et al. (2006) note the need for the early use of a specific supervision model, which could be used right away in their supervision career, and this was perceived to alleviate the anxiety of being in a new role. One such model is proposed by Geller (2002), who suggests an educational framework comprising developmental, collaborative and reflective theoretical constructs in order to support supervisees’ learning. This means, for example, that there exists a transition from where supervisees consider answers to be either right or wrong to considering a problem from multiple perspectives or paradigms. Furthermore, Gürsoy et al. (2013) and Shealy (2004) introduce a supervision learning model. To improve supervision skills, referring to the quality of giving feedback and communication, a stable model that emphasises cooperative planning, observation and feedback is suggested and discussed.

Flanagan and Grehan (2011) list the qualities that are needed to be a good supervisor. These qualities – flexibility towards several theoretical concepts, the ability to see different perspectives and work with diversity in individuals, being a continual learner and able to handle power – are proposed as desirable, and thus appear sensible to pay attention to in supervision training (Flanagan and Grehan, 2011). In addition, Daugherty (2011: 474) lists the following traits of a good supervisor: spending time, being available, mentoring, teaching, helping, communicating, showing, explaining, interacting, cooperating, offering feedback, answering questions and giving direction, as well as ‘mentoring and teaching qualities, such as being open, approachable, friendly, and helpful and taking time to teach, give direction, and provide support’. Several of the search outcomes in this literature study mention appreciation for coupling theory with practice (for example, Nilsen et al., 2012; Ringsted et al., 2004). The challenge exists between an atheoretical, practical, hands-on training on the one hand, and an over-theorised abstract supervisor course on the other hand. Geller (2002) refers to previous research, claiming that current approaches to supervision are not based on theoretical models of supervision, and are developed in a rather atheoretical manner. One question is whether the claim about supervision being not based on theory is still appropriate.

A solid supervisor support model, method, protocol, guidelines or competence framework based on learning theory appear to be things that are requested in supervision training. By contrast, Flanagan and Grehan (2011) argue that supervisors use a variety of methods in supervision practice. It seems that there is no gold standard that is always applicable in any given supervision situation, and from the articles referred to, there seem to be two ways of viewing supervisory models: one that takes a method and guideline approach (for example, Flanagan and Grehan, 2011), and another that draws on learning theories for supervisees’ competence development (for example, Gürsoy et al., 2013).

In supervision courses, it is clear that an important challenge is to balance an atheoretical, practical, hands-on training course against an over-theorised, abstract supervisor course. Supervisors-to-be need theoretical knowledge about a solid support model on the relation between theory and practice, as well as generic know-how about how to develop behaviours of good and desirable supervision. Supervision training courses could integrate theoretical perspectives into the other four content elements discussed above.

The aims of this study included exploring whether the content elements may constitute challenges in supervision, and thereby create fields of tension when incorporating them in supervision. During our critical review and analysis of the results of our systematic literature review, we identified four fields of tension. There was a recurring pattern of contradictions in the articles, and it is these conflicts and fields of tension that we address in this section. The four fields of tensions presented below can be seen as dialectical, as a large focus on, for example, practice risks reducing the role of theory. At the same time, fields of tension can be useful for visualising the focus of the supervision, and as a tool for the supervisor to actively choose content. The fields of tension can also form a basis for discussion between supervisors in a supervisor’s college or in supervisor training, to reflect on the considerations that a supervisor must take into account.

From the analysis, we conclude that assessment, as well as feedback, in supervision situations tends to be closely related to performing tasks adequately and professionally. This means that supervisors need to consider both the theoretical and the practical parts of the tasks, and help supervisees integrate theory with practice (for example, Nel et al., 2012). Furthermore, several studies (Sagasser et al., 2015; Ybrandt and Armelius, 2009) have highlighted the assessment aspect of supporting supervisees to become increasingly autonomous and able to perform tasks on their own, and other organisational aspects related to the content elements of supervision. One major organisational problem seems to be finding time to provide adequate and professional supervision (for example, Mahasneh et al., 2020). In this regard, it is also possible to identify the dual roles of the supervisor as an expert related to the profession and as knowledgeable in supervision; these roles need to be undertaken within ordinary work (for example, Wisker and Claesson, 2013).

Based on our analysis, four fields of tensions were identified:

theory versus practice: integrating theory with practice

A summation of our analysis reports that the first identified tension is between theory and practice; this tension is ever-present, and it highlights the pull between context-free know-what, on the one hand, and the practical application of know-how, on the other hand. The second tension is how supervision is squeezed in between fostering independent future practitioners and ensuring a safe learning environment. Third, the supervisor has the role of being a specialist, but also that of a supervisor. Closely connected to the previous tension is the expectation that supervisors will deliver ordinary service to, for example, patients, and, at the same time, pay attention to the supervisee and their learning process.

Although the identification of relevant search terms was a systematic and extensive process, the study has certain methodological shortcomings. The search outcomes were sifted based on article title and abstract, which means that there may have been a risk of missing articles where the relevant subject was not clear from the title or abstract. One shortcoming was that articles focusing on workplace induction were collected and not relevant for our study. Another was that search outcomes were dominated by clinical supervision examples from the medical field, and thus did not completely represent supervision experiences and content in vocational supervision training courses in general.

It is possible to conclude, generally, that studies related to medical supervision are overweighed. However, the chosen content elements have been studied from a variety of professions (for example, Attrill et al., 2020; Donaghue, 2020). As the above results show, these aspects are often intertwined as, for example, studies focusing on assessment may involve feedback (for example, Govaerts and Dochy, 2014; Govaerts et al., 2017), and research aiming to explore feedback touches on communication. Thus, there is a methodological indistinctness connected to aspects being intertwined. There were 10 studies that were categorised as belonging to more than one aspect. Most importantly, relevant studies have been identified and included in this literature review.

How are the five content elements constituted in vocational supervision training courses and educational supervision training? This section provides a synthesis and discussion around what emerged in the systematic literature review in connection to the five content elements of assessment, communication, ethics, feedback, and learning and supervision theories.

It is evident from the review that the five content elements compound important parts of supervision and supervision training. However, several authors (for example, Blackman and Schmidt, 2013) place higher importance on competences related to specific aspects, such as feedback and communication. Furthermore, the aspect of assessment gets many ‘hits’ in the sifting process, which is likely to mirror the sense of its importance in supervision settings, as well as potential anxiety in supervision training. Communication, feedback and assessment are imperative in order for supervisees to make progress and to reach learning goals and improve their confidence. The included studies point to balanced and timely feedback, as well as to a need to practise developing trainees’ disciplinary competence and an increased degree of independence and self-assessment as a tool for lifelong learning (for example, Sturman et al., 2020). Furthermore, recordings and role play have been put forward as ways to support supervisors in training to have critical reflective conversations, and to develop an understanding of how to improve their communication skills.

The content element with the lowest number of articles refers to ethical considerations (N = 9). As pointed out in the section above, the articles that refer to ethical aspects in supervision situations (for example, Oerlemans et al., 2017) are also related to ethics in work practice, such as between doctor and patient (for example, Flanagan and Grehan, 2011). If we only consider ethics in supervision, there seems to be a lack of studies. To discuss different stereotypes and supervision, behaviour should be relevant in all supervision courses. A framework for ethical behaviour for the supervision relationship can be problematised in supervision training courses in connection to desirable and undesirable supervision behaviour.

When it comes to learning and supervision theories, supervisory courses need to consider theories such as developmental, collaborative and reflective theoretical constructs (for example, Geller, 2002), in order for supervisors to support supervisees’ learning. The theoretical approaches are also connected to other content elements, as supervisors need training in increased quality of giving feedback and communication (for example, Gürsoy et al., 2013). From this review, learning and supervision theories are required to include and problematise the relationship between theory and practice. Neither an exclusively theoretical nor a purely practical perspective is desirable in supervision training courses; both perspectives are desirable. Although some content elements are emphasised as being particularly important, the five discussed aspects may constitute a more complete portfolio of competences for supervision.

Four fields of tension have been identified in this study: (1) integrating theory with practice; (2) making the supervisee autonomous; (3) being a field expert as well as a supervisor; and (4) providing adequate supervision and ordinary service. These tensions may become explicit in supervisor courses, but also in supervision situations. Furthermore, there is a continuum in a dialectic relationship, and it is possible to move along the spectrum, depending on where emphasis is placed. In certain situations, the fields of tension and what to focus on may be controversial, and it is likely that different people have different viewpoints regarding what to focus on. The four tensions can serve as a tool for individualised supervision (Luiselli et al., 2017), where the supervisor could approach different learning situations with different focuses. This means that the supervisor, in an explicit way, could come closer to the supervisee’s needs, and also adapt planned learning activities (Blackman and Schmidt, 2013) to the fields of tension.

The real challenge for both supervisor and supervisee is to realise that both parts of the tensions are needed, and must be integrated into the supervision practice; it is not a question of either/or. Another problem is to find, in a given context, a reasonable and suitable balance between the pairs of concepts in the four fields of tension.

The findings presented in this article are based on a syllabus analysis and a systematic literature review. As discussed, this review takes a broad focus and includes five content elements found in supervision training syllabuses. A future review could centre on just one element in order to scrutinise existing studies in greater depth. Future research would benefit from being empirical, based on, for example, observations of authentic supervision practice. Which actual content elements of our previous findings are included in the supervision? How is assessment discussed? How is the communication organised? How are supervisees prepared when it comes to ethical challenges? How do supervisors provide feedback, and how do supervisees appreciate and understand the feedback they receive? Which teaching and learning theories frame the entire supervisor environment? Finally, a suggestion for future research is to critically problematise how the entire supervisor practice can be improved, from both the supervisor’s and supervisee’s perspective, based on the questions above.

In addition, empirical studies are needed in connection with the four identified fields of tensions. How do supervisors and supervisees balance and navigate between theory and practice, between being independent and dependent, and between being an expert and at the same time providing ordinary service? Studies involving the practice of supervision should generate relevant new knowledge concerning these questions.