Bridge Builders: A Qualitative Study of Fellows’ Successful Supervision of Residents

Abstract

Purpose Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows’ supervision of residents. The aim of this study was to understand residents’ and fellows’ perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors. Method Using grounded theory methodology, the authors held focus groups in May 2020 of pediatric residents and pediatric subspecialty fellows at Boston Children’s Hospital, Boston, Massachusetts. Focus groups were conducted until thematic saturation was achieved. Deidentified transcripts were independently coded by 2 authors. The author team consolidated the codes into themes and developed an interpretive model for fellows’ successful supervision of residents. Key results were confirmed via member checking. Results The authors conducted 4 resident focus groups, composed of 16 pediatric residents, and 4 fellow focus groups, composed of 13 pediatric subspecialty fellows. Participants perceived that fellows who provided successful resident supervision advanced residents’ professional growth and supported residents’ development along 5 “bridges”: (1) generalist to subspecialist, (2) trainee to autonomous practitioner, (3) individual to member of the interprofessional team, (4) emerging physician to patient-facing care provider, and (5) newcomer to engaged clinical learner. Fellows can further residents’ growth in these areas by demonstrating approachability, empathy, appreciation, and kindness. Conclusions As newcomers on inpatient subspecialty rotations, residents engage in legitimate peripheral participation. Fellows who are successful supervisors move residents toward full participation in their profession via the bridge model. The fellow-resident dynamic carries advantages of near-peer learning. Fellows can harness their role, subspecialty knowledge, and familiarity with the training environment to enhance resident supervision.

Social Care Education and Training Among US Pediatric Emergency Medicine Fellowship Programs

“…However, the ED visit may be a child's first or only point of healthcare access, making PEM fellowship arguably the ideal time to garner competency in social care 25 . In addition, fellows are uniquely situated as near-peers to medical students and residents as well as leaders in ED management, which may leverage their ability to advocate for change in social care education, training, and infrastructure 17 …”

“…16 Given their various roles in clinical leadership, patient advocacy, and research at the generational crux of medical education innovation, PEM fellows are uniquely positioned as movers and shakers in the field of social care. 17 Pediatric emergency medicine fellows highly value social care but only a minority report feeling prepared to assist patients and their families with social needs. 16 While the Accreditation Council for Graduate Medical Education requires that PEM fellows demonstrate "awareness" and "responsiveness" to the patient's social context, the majority of PEM training programs lack organized curricular intervention facilitating routine social care in the emergency department (ED).…”

“…Recent national research showed, however, that only a minority of pediatric emergency medicine (PEM) fellows receive education in SDOH and training in social care during fellowship 16 . Given their various roles in clinical leadership, patient advocacy, and research at the generational crux of medical education innovation, PEM fellows are uniquely positioned as movers and shakers in the field of social care 17 …”