Firstly, our study suggests that a supervision structure relying heavily on performance evaluations may induce substantial anxiety among providers and exacerbate the inherent power imbalance. The supervisory encounter in our material appeared to revolve around the performance indicators that supervisors mark, much like students may focus on subjects that are to be assessed in examinations.36 This may limit attention on the vastness of activities and work problems not included in evaluation checklists.37 Suggestions for structural changes were given in another paper,14 such as pre-announcing the date of evaluations and reducing the monthly frequency of evaluation visits to give supervisors time to offer formative encounters.