Metacognitive Reflection in Supervision: the Role of Supervision in Addressing Health Inequities

Research demonstrates ongoing health inequities for those from the most marginalized communities. To address these health inequities, medical educators have attempted to incorporate education that targets cultural competence of providers. Over the last decade, increasing evidence has demonstrated limitations to a competency-based approach. In this paper, we outline how utilizing critical reflection strategies in clinical supervision can be a long-term, sustainable approach for addressing health inequities, while improving the existing cultural competency model. We begin by demonstrating how existing ideas of critical reflection can be adopted to enhance learning within supervision by encouraging providers to evaluate and re-evaluate existing beliefs and biases. We then propose how an existing approach to treatment (i.e., Metacognitive Reflection and Insight Therapy) may serve as an example for how to activate critical reflection in supervision using three essential factors. Finally, we propose three clinical implications for providers that may work to dismantle existing healthcare inequities including: an increased comfort in feedback seeking, improved confidence working with diverse populations, and increased insight into how inequities emerge in clinical practice and how best to respond when they do.