Principles and Financing of Supervision in Specialist Training in Psychosomatic Medicine and Psychotherapy:
Supervision is a core component of the personal direction of specialist training by the authorized training physician.
“Supervision is the professional consultation, guidance, and review of a diagnostic or therapeutic process by a specialist in Psychosomatic Medicine and Psychotherapy authorized for this purpose who has several years of experience in psychotherapy following specialist recognition.” This is how it is defined in the glossary of the Model Specialty Training Regulations.
Supervision therefore means the continuous monitoring by the authorized training physician of treatments carried out as part of specialist training. It is most comparable to a senior physician’s ward round on an internal medicine ward.
It is routinely and continuously provided by the authorized training physicians present at the workplace of the physicians in training.
Ideally, depending on need, this takes place immediately before and after the respective treatment or in between, but it can and should also be consolidated into specifically designated supervision sessions.
Since the regular supervisor is the same person who personally directs the specialist training, continuous monitoring of treatment and any necessary intervention are always ensured – just as in all other medical specialties.
Supervision is not inherently an “external” service, although it may alternatively be provided externally. In that case, it becomes a delegated or externally commissioned component of specialist training arranged by the authorized training physician.
Some State Specialty Training Regulations require multiple supervisors. In doing so, they impose an obligation on authorized training physicians to provide these supervisors, while at the same time relieving them of parts of their core responsibilities.
This must not result in any disadvantage for physicians in training.
However, authorized training physicians retain ultimate responsibility and must remain available at all times to physicians in training as the responsible point of contact, including for treatments supervised externally.
Requirements according to the Specialty Training Regulations (WBO):
- As a rule, 30 minutes of supervision after 4 treatment sessions, depending on the treatment process
- Supervision may also be conducted in groups of up to 6 participants for a duration of 90 minutes
- These requirements merely define the general framework
Selection of an External Supervisor
Authorized training physicians, who are required to personally direct specialist training in accordance with the applicable laws governing chambers of healthcare professionals and the Specialty Training Regulations, must remain in contact with external supervisors or be able to establish such contact easily at any time because they retain ultimate responsibility for patient treatment. Conversely, external supervisors must likewise remain in contact with the authorized training physicians, as they do not bear ultimate responsibility for treatment.
To ensure this, external supervisors must be approved by the authorized training physicians.
Upon approval, physicians in training are released from their contractual confidentiality obligations regarding the business secrets of the training institution insofar as these are relevant to treatment.
If physicians in training choose an external supervisor entirely freely without approval, they are in breach of their employment contract!
Structure of Supervision
The requirements of the WBO provide an indicative framework of 30 minutes of supervision after 4 treatment sessions. This merely establishes a general framework. The treatment process is therefore specified as the determining factor.
The authorized training physicians who are continuously present at the workplace of the physicians in training (personal direction of specialist training) are always available to provide flexible and supportive monitoring, including for treatments that are supervised externally.
In addition, fixed appointments for supervision are arranged.
Supervision is a core responsibility of authorized training physicians and is therefore naturally part of the employment contract subject to social security contributions, which is required for specialist training, and therefore does not incur any costs for physicians in training.
Delegated supervision likewise does not incur any costs for physicians in training. Since delegation partially relieves authorized training physicians of their duties and allows them to carry out other remunerated work during this time, payment for external supervision is the responsibility of the authorized training physicians.
Integrated Specialist Training for the Additional Qualification in Psychoanalysis
In this case, there is no obligation for the employer providing specialist training to cover the costs, but financing may be negotiated on a voluntary basis.