Council on Medical Student Education in Pediatrics


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Letting go

How clinical supervisors develop trust in their trainees: A qualitative study. Hauer KE et al. Medical Education 2015; 49: 783-795.

Reviewed by Nicholas Potisek

What was the study question?
How do clinical supervisors develop trust in their trainees?

How was the study done?
Forty-three internal medicine (IM) supervisors from inpatient IM services who worked in the previous 3 months and for a minimum of 7 days with IM residents participated. Participants completed a demographic survey and an interview describing the development of trust and what it means to trust a resident with patient care responsibilities. From a sample of transcripts, research team members developed a codebook to identify themes of trust and then applied code to all transcripts and achieved group consensus on code application.

What were the results?
Participants described the meaning of trust as an awareness of a resident’s competence and limitations balanced with directly observed leadership skills. The development of trust had various starting points, similar strategies of supervision, and time to formation. Supervisors often used a combination of some standard for comparison, direct observation, and information from team members as sources for trust development. Numerous barriers and accelerators to trust development were identified, which related to the resident, the supervisor, the resident-supervisor relationship or the task at hand. Trust formation allowed supervisors to adjust roles focusing more on teaching and consultation; trainees were perceived to provide patient care more independently; and team dynamics were improved.

What are the implications of this study?
An improved understanding of trust development and barriers to this process can guide supervising physicians to prepare trainees for the ultimate goal of unsupervised practice. This information can also promote trust development in curriculum design to facilitate this process in the supervisor-resident relationship.

Editor’s note: Knowing when to give autonomy to trainees is a crucial aspect of that training as well as an essential component of patient care when trainees are involved (RR).

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