Lack of consensus in supervision.

This study describes what occurs when trainees and supervisors encounter a lack of consensus in supervision. We identified 120 episodes indicating a lack of consensus between a supervisor and a trainee during 23 hr of supervision. Qualitative analysis of the episodes described 10 supervisor responses, characterized as influence and evaluation, and eight trainee responses, characterized as cooperation and deference. The pattern of supervisor-trainee interaction was characterized by negotiation and collaboration. Supervisors and trainees collaborate to produce a presentation of the trainee as a competent clinician and a cooperative trainee. Supervisors identify deficiencies and offer requests in a subtle manner that appears open to modification, thus cooperating with the trainee's competent and cooperative image.