Continuity of supervision: Balancing continuous and episodic relationships for assessment and learning.

Introduction: Meaningful supervisor-resident relationships enhance feedback and learning, yet not all relationships reach this potential. While there is increasing interest in continuity of supervision (CoS) to build relationships that support feedback and promote learning, there remains a limited understanding of how relationships develop and influence assessment over time. The aim of this study was to explore how supervisors and learners in postgraduate medical education perceive CoS relationships and their impact on feedback and assessment.

Methods: We used constructivist grounded theory informed by the educational alliance to develop insight into how supervisor and resident perceptions of episodic and continuous relationships impact feedback and assessment. We interviewed 22 participants, including 14 family medicine residents and eight faculty advisors. We iteratively analysed the data concurrently with data collection.

Results: In episodic relationships, participants accepted superficiality for variety and diversity in feedback. In continuous relationships, we identified four sub-types. Our participants described how each of these relationships impacted their perceptions of the feedback and assessment information given or received and resulted in different steps taken in response to their perceptions: (i) Not developing-tolerate feedback and seek out additional assessors, (ii) deteriorating-avoid feedback and seek out alternative assessors, (iii) developing-value and tailor feedback and (iv) becoming a friendship-question bias in feedback and advocate for more assessors.

Conclusions: Episodic and continuous relationships offered feedback and assessment value. However, deeper analysis of the continuous relationships revealed additional complexity. Understanding the nuances of CoS relationships is important for supporting successful relationships and improving feedback and assessment.