How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students?

Introduction: Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed. Methods: The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice. Results: A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.". Discussion: The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.