A SMART framework for equitable supervision: Insights from a longitudinal study with BIPOC genetic counseling students

The Reciprocal Engagement Model of Supervision (REM-S) draws a parallel between the relationships genetic counselors establish with their patients and those they establish with their supervisees, in both cases highlighting the need for a strong working alliance and clear communication. However, even when supervisors strive to create a positive environment, the hierarchical and professional gatekeeping nature of the relationship may be anxiety-provoking for students. Black, Indigenous, and People of Color (BIPOC) students may be particularly impacted by this power differential due to their marginalized identity. The purpose of this article is to investigate the experiences of BIPOC genetic counseling students during their supervised clinical rotations and to propose interventions for supervisors to implement that enhance psychological safety and student learning. We conducted semi-structured interviews with 25 participants who were part of a longitudinal constructivist study investigating the training experiences of BIPOC genetic counseling students. Using reflexive thematic analysis, we identified relational and structural factors that impacted the participants' experiences. Relational factors included whether the supervisor was perceived as supportive and as modeling a growth or judgment mindset. Structural factors related to the rotation included whether it was well-organized and allowed the student independence during counseling sessions. Structural factors related to feedback included the style, content, and timing of feedback. Due to the supervisory power dynamic, relationships between genetic counselors and their students are different than those with their patients, and we recommend integrating literature regarding psychological safety with the REM-S to create a learning environment that encourages the interpersonal risk-taking needed to learn clinical skills. In addition, we propose a system for co-creating relevant, personalized SMART goals that integrate the PBCs and rotational activities to enhance student learning. This framework for SMART supervision can be implemented in a wide range of contexts to create a more equitable supervisory experience.