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Effects of coaching supervision, mentoring supervision and abusive supervision on talent development among trainee doctors in public hospitals: moderating role of clinical learning environment
© Subramaniam et al. 2015
Received: 4 July 2014
Accepted: 7 July 2015
Published: 13 August 2015
Effective talent development requires robust supervision. However, the effects of supervisory styles (coaching, mentoring and abusive supervision) on talent development and the moderating effects of clinical learning environment in the relationship between supervisory styles and talent development among public hospital trainee doctors have not been thoroughly researched. In this study, we aim to achieve the following, (1) identify the extent to which supervisory styles (coaching, mentoring and abusive supervision) can facilitate talent development among trainee doctors in public hospital and (2) examine whether coaching, mentoring and abusive supervision are moderated by clinical learning environment in predicting talent development among trainee doctors in public hospital.
A questionnaire-based critical survey was conducted among trainee doctors undergoing housemanship at six public hospitals in the Klang Valley, Malaysia. Prior permission was obtained from the Ministry of Health Malaysia to conduct the research in the identified public hospitals. The survey yielded 355 responses. The results were analysed using SPSS 20.0 and SEM with AMOS 20.0.
The findings of this research indicate that coaching and mentoring supervision are positively associated with talent development, and that there is no significant relationship between abusive supervision and talent development. The findings also support the moderating role of clinical learning environment on the relationships between coaching supervision-talent development, mentoring supervision-talent development and abusive supervision-talent development among public hospital trainee doctors. Overall, the proposed model indicates a 26 % variance in talent development.
This study provides an improved understanding on the role of the supervisory styles (coaching and mentoring supervision) on facilitating talent development among public hospital trainee doctors. Furthermore, this study extends the literature to better understand the effects of supervisory styles on trainee doctors’ talent development are contigent on the trainee doctors’ clinical learning environment. In summary, supervisors are stakeholders with the responsibility of facilitating learning conditions that hold sufficient structure and support to optimise the trainee doctors learning.
The success of healthcare systems worldwide hinges on the development and competence of its doctors . According to evidence-based management theory, doctors possess craft that can be learned/developed with appropriate guidance through practice and experience . Housemanship provides trainee doctors the chance to perform required medical procedures and undertake clinical practice under supervision . Existing studies have emphasised medical education and training, illustrating a cognitive ‘schooled’ approach that emphasises on competence-based development for young doctors . The indicators of competence in medicine are derived to evaluate the qualities necessary for a medical practitioner to function effectively, which includes professional and medical competencies . Nevertheless, controversy exists on how to develop these competencies . These set of competencies are widely known as talent. In the existing state of the art the trainee doctors’ talent development has not been identified and investigated extensively.
In this study, talent development refers to the competency development for medical practitioners that is geared towards producing competent professionals with necessary skills for medical practice. Effective talent development approach requires robust supervision . In the healthcare environment, supervisors are portrayed as role models for young doctors. Thus, healthcare supervisors should portray qualities that include the abilities to communicate, inspire, to demonstrate integrity, honesty and consistency . Prior scholars asserted that supervisory styles have significant implications for trainee doctors’ talent development . For instance, coaching , mentoring  and abusive supervision  have been utilised to establish the relationship between supervision and performance. The causal relationships between these aspects lead towards talent development in healthcare setting. Through supervisory coaching, supervisors who pass on accumulated “wisdom” to their mentees led to the development of young talents . Mentoring supervision has been described as “an experienced person who goes out of his/her way to help a mentee set important life goals and develop the skills to reach them” . On the other hand, abusive supervision leads to individuals being exhausted and incompetent [8, 11]. Despite the contrasts in the different supervision styles, few studies have provided support linking supervisory styles with talent development among public hospital trainee doctors.
For trainee doctors, their competency level lies in high-quality supervised training that provides exposure to various medical cases, treatment scenarios and diagnostic tools—all of which indicate a favourable clinical learning environment . A favourable clinical learning environment is termed as one that provides organisational and socio-cultural interactions that support trainee doctors’ entry to the formal and technical elements of the environment . Such an environment provides organised activities, resources and chances for practice . Undeniably, a favourable clinical learning environment is one of the most essential aspects of the quality of medical training . Prior work in this area asserted that a favourable clinical learning environment enhances the effects of coaching  and mentoring supervision  on trainee doctors’ talent development. Similarly, the relationship between abusive supervision and talent development is contingent on a favourable clinical learning environment . Despite their importance, researches on the moderating effects of clinical learning environment in the following relationships among public hospital trainee doctors are limited: between coaching supervision-talent development, mentoring supervision-talent development and abusive supervision-talent development.
Prior scholarly efforts in talent development in healthcare environment tend to focus on conceptual ideas that often lack empirical evidence. It is clear that development of trainee doctors’ competencies (talent development) is dependent on high-quality supervised training . This can be further enhanced by generating a favourable clinical learning environment . Nevertheless, there is lack of studies that integrate the concepts of supervisory styles with talent development and examine whether a favourable clinical learning environment influences these relationships. In this regard, the contribution of this study is significant.
H1: Coaching supervision is positively related to talent development.
H2: Mentoring supervision is positively related to talent development.
H3: Abusive supervision is negatively related to talent development.
H4: Clinical learning environment moderates the relationship between coaching supervision and talent development.
H5: Clinical learning environment moderates the relationship between mentoring supervision and talent development.
H6: Clinical learning environment moderates the relationship between abusive supervision and talent development.
The study was carried out in Malaysia—an emergent Southeast Asian country. Participants were trainee doctors from six Malaysian public hospitals in the Klang Valley area. Prior approval was attained from the Ethics and Research Committee of Ministry of Health Malaysia to conduct research, which eased access to six hospitals. A questionnaire-based critical survey was conducted among the individual trainee doctors. The Human Resource (HR) Training Unit at each hospital assisted in the distribution of the questionnaires. The trainee doctors were given the option to refuse participation. It was made clear that returning the questionnaire after completion was considered as informed consent for participation in the study. Out of 450 distributed questionnaires, 355 were completed and had usable responses.
Coaching supervision was measured using the 11-item scale . A 5-point rating scale (1 = Do not facilitate, 5 = Highly facilitate) was utilised to measure the extent to which the trainee doctors perceived that their immediate supervisors had the following behaviour(s) in relation to coaching supervision that in turn could assist in facilitating their talent development. Mentoring supervision was measured using a 15-item scale , composed of three dimensions: (1) Psychosocial support, (2) Career development and (3) Role modelling. The extent to which the trainee doctors perceived that their immediate supervisor in relation to mentoring supervision and behaviour was measured on a 5-point Likert scale (1 = Do not facilitate, 5 = Highly facilitate). Abusive supervision scale was measured using a 15-item scale . A 5-point rating scale (1 = Do not facilitate, 5 = Highly facilitate) was utilised to measure the extent to which the trainee doctors perceived that their immediate supervisor possess attributes indicating abusive behaviour or supervision that could hinder their talent development. Conversely, the rating scale is also used to identify attributes that assist in facilitating positive development in the trainee doctor experience in the medical housemanship.
In this paper, clinical learning environment was measured using the 10-item scale  comprised of three dimensions: (1) Conditions for Learning, (2) General Learning Activities and Resources and (3) Opportunities to perform rotation-specific clinical skills and assessment. The extent to which the trainee doctors agree with the statements pertaining to the aspect of clinical learning environment that could facilitate talent development was measured on 5-point Likert scale (1 = Do not facilitate, 5 = Highly facilitate). The measurement scale for talent development comprised 13 items , inclusive of a number of competence items. Each component of professional and medical competencies computes several aspects of competencies needed by trainee doctors for independent practice. These are classified into three dimensions: (1) Clinical competence, (2) Communication competence and (3) Personal and professional competence. Each of the items relating to competencies was rated on a 5-point rating scale (1 = Do not facilitate, 5 = Highly facilitate).
In order to assess the extent of common method variance, Harman’s one factor test  was carried out. All the scale items were inserted into an unrotated factor analysis to identify whether a single factor accounted for the majority of covariance among the constructs. This process results in a seven factor (Eigenvalues greater than 1.0) solution, whereby the first factor accounted for 33.72 % of the variance, which is less than 50 %. This indicates that the common method bias does not appear to be a serious problem in the study.
SPSS 20.0 was employed to analyse preliminary data, while the rest used Amos 20.0 for SEM as it quantifies the theoretical relationships of constructs that combines regression and factor analysis . The proposed model was tested by utilising a two-stage approach (measurement and structural model assessment).
Measurement model assessment
The measurement model is analysed using Confirmatory Factor Analysis (CFA) and evaluated in two conditions: (1) unidimensionality for each scale and (2) reliability and validity of each constructs.
Measurement model evaluation
Standardized loading (λ)
C1 to C11
(Between 0.70 and 0.81)
PSY1 to PSY5
(Between 0.80 and 0.89)
CD7 to CD11
(Between 0.79 and 0.89)
RM13 to RM15
(Between 0.78 and 0.97)
AS1 to AS15
(Between 0.74 to 0.95)
CL1 to CL6
(Between 0.78 and 0.89)
(Between 0.79 and 0.83)
(Between 0.88 and 0.92)
CLI1, CL2, CL4
(Between 0.72 and 0.86)
(Between 0.79 and 0.86)
PER8, PER11, PER12, PER13
(Between 0.73 and 0.80)
Cronbach’s  alpha indicator must be greater than 0.70 for each construct to support reliability;
Composite reliability should be equal to or greater than 0.60 ;
Construct validity obtained from goodness-of-fit indices ;
Average extracted variance (AVE) should be equal to or greater than 0.50 to support convergent validity ; and
AVE must be greater than the squared correlation estimates of among the constructs to support discriminant validity .
Descriptive statistics, reliability and validity results
95 % CI
AVE of each construct and the squared correlation estimates are illustrated in Table 2, together with mean, standard deviation and 95 % confidence interval of each construct. From the values of AVE and squared correlation estimates, it is evident that the criteria for convergent and discriminant validities of each construct is satisfied. Moreover, with respect to the mean value, a score of 3.5 or more indicates high agreement with a particular criterion, whereas a score of more than 2.5 but less than 3.5 indicates moderate agreement. Similarly, a score less than 2.5 indicate low agreement with a criterion. Based on the mean values of the constructs, public hospital trainee doctors have high preference for coaching supervision (mean = 3.91) and mentoring supervision (mean = 3.61), but low preference for abusive supervision (mean = 2.25), as well as an optimal clinical learning environment (mean = 3.85) and talent development (mean = 3.85).
Structural model assessment
Results of the structural model
Path From → To
CS → TDEV
MS → TDEV
AS → TDEV
CLE → TDEV
CS → CLE
CS*CLE → TDEV
MS → CLE
MS*CLE → TDEV
AS → CLE
AS*CLE → TDEV
Table 3 reveals that the path between coaching supervision and talent development (β = 0.200, p = 0.001), as well as mentoring supervision and talent development (β = 0.121, p = 0.019). These values are statistically significant, thus hypotheses H1 and H2 is supported. Nevertheless, the results do not establish support for hypothesis H3, where the path between abusive supervision and talent development is not statistically significant (β = −0.027, p = 0.597).
To test the moderating effects of clinical learning environment several constructs including the exogenous constructs (coaching, mentoring and abusive supervision), the moderating construct (clinical learning environment) and the interaction term [coaching supervision x clinical learning environment; mentoring supervision x clinical learning environment; and abusive supervision x clinical learning environment] were regressed on endogenous construct (talent development). Table 3 shows the output of the analysis process. Since the interaction term implies a statistically significant amount of variance in the endogenous construct, a moderator effect is present. This indicates that clinical learning environment moderates the relationship between (1) coaching supervision and talent development (β = 0.296, p = 0.002), (2) mentoring supervision and talent development (β = −0.259, p = 0.006) and (3) abusive supervision and talent development (β = 0.170, p = 0.001). With these values, hypotheses H4, H5 and H6 are supported. Overall, the model explains 26 % of the variance in talent development.
The findings of the study are consistent with prior research [9, 48] that indicate coaching supervision facilitates talent development. Thus, healthcare professionals should conduct training and educational programmes for supervisors on how to serve as coaches. As revealed by prior work , the findings also show that the relationship between coaching supervision and talent development is stronger when trainee doctors perceive a favourable clinical learning environment. This observation in the prior work gives credence to the finding and relevance of this effort. Thus, healthcare administrators should provide a favourable clinical learning environment to enhance trainee doctors’ talent development. This can be conducted by providing trainee doctors the chance to repeat the learned skills and in different situations and contexts (mixed practices) until they become competent. Furthermore, continuous feedback should be provided as this will help to improve their competency level by understanding the outcomes of their performance.
As noted in prior research [10, 49], mentoring supervision facilitates talent development. Thus, mentoring supervision can be incorporated into housemanship by training supervisors on how to develop their interpersonal capabilities, relationship skills and conflict resolution assistance. Furthermore, trainee doctors can be encouraged to reflect on their learning by allowing them to conduct case presentations and constantly provide feedback. Results further indicate that the interaction between mentoring supervision and talent development is stronger when trainee doctors perceive a favourable clinical learning environment. Thus, supervisors can provide trainee doctors with relevant chances to observe patients with variations of clinical problems.
Results of this study indicate that coaching supervision is a contributing factor towards talent development compared to mentoring supervision. Supervisors could coach trainee doctors by selecting tasks that are suitable to their capabilities, offer critical evaluation of this capability, dispensing advice, formulating a process to execute tasks and developing a structured way to address weaknesses.
The findings of this study are consistent with that of prior research work  that show abusive supervision does not have any direct effect on talent development. Supervisees were found to be highly responsive towards negative aspects of external context, which tends to have strong effect on attitudes and behaviour compared to positive contextual aspects . Trainee doctors’ supervisors are likely to retaliate or emulate their supervisors with mistreatment to enhance supervisees’ talent development. Nevertheless, negative experiences due to supervisory abuse are lessened when trainee doctors encounter a favourable clinical learning environment, which could enhance their talent development. For this reason, a favourable clinical learning environment for trainee doctors is necessary towards nurturing and motivating them to apply their potential in enhancing their talent development . Furthermore, public hospital administrators should conduct training programmes for trainee doctors to eliminate problems that arise during the housemanship tenure and encourage them to become confident in facing negative consequences in their learning environment. Additionally, a grievance or ombudsman system  for trainee doctors is needed to prevent supervisory abusive during housemanship.
These findings imply that clinical learning environment plays an important role on supervisory styles in facilitating talent development. Thus, public hospital administrators should support trainee doctors’ talent development by providing sufficient specialty services, mixture of cases and specialists to ensure effective supervision. It is essential to monitor trainee doctor progress through training programmes as well as feedback and appropriate opportunities to maximise learning .
From the theoretical standpoint and theory building, this study has contributed toward the work on talent development among medical practitioners. This study has attempted to improve the understanding on the supervisory styles that can facilitate talent development among public hospital trainee doctors. It is observed that the interactional effects of clinical learning environment are essential for the delivery of quality supervisory training thus enabling public hospital trainee doctors’ talent development. This study and findings also deepens our understanding of the underlying mechanisms that are responsible for the direction/strength of the relationship between supervisory styles and talent development.
In summary, supervisors have the responsibility of providing learning conditions that hold sufficient structure and support trainee doctors’ learning. The assessment by the supervisor of trainee doctor development level shall help in identifying the optimal learning environment for trainee doctors. Furthermore, public hospital administrators can develop training modules to address trainee doctors’ needs and generate an environment that will encourage them to apply their skills.
Given the limitations of the cross-sectional design, future studies should consider longitudinal data to establish causal relationships and to identify developmental changes over time among these constructs. The sample of this study included public hospital trainee doctors only, it follows that due the similar characteristics and scenario including private hospital trainee doctors is likely to present interesting relationships and differences. Finally, the model explains 26 % variance in talent development. The percentage of the explained variance of trainee doctors’ talent development could in fact be related to constructs other than the studied ones. Future research could design model that incorporate the differences in the constructs.
The authors wish to thank the Ministry of Health, Malaysia for giving consent to conduct the study. The authors also thank the authorities of the public hospitals and the trainee doctors who participated in the study.
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