How supervisor trust affects early residents’ learning and patient care: A qualitative study

Abstract

Introduction Trust between supervisors and trainees mediates trainee participation and learning. A resident (postgraduate) trainee’s understanding of their supervisor’s trust can affect their perceptions of their patient care responsibilities, opportunities for learning, and overall growth as physicians. While the supervisor perspective of trust has been well studied, less is known about how resident trainees recognize supervisor trust and how it affects them. Methods In this qualitative study, 21 pediatric residents were interviewed at a single institution. Questions addressed their experiences during their first post-graduate year (PGY-1) on inpatient wards. Each interviewee was asked to describe three different patient care scenarios in which they perceived optimal, under-, and over-trust from their resident supervisor. Data were analyzed using thematic analysis. Results Residents recognized and interpreted their supervisor’s trust through four factors: supervisor, task, relationship, and context. Optimal trust was associated with supervision balancing supervisor availability and resident independence, tasks affording participation in decision-making, trusting relationships with supervisors, and a workplace fostering appropriate autonomy and team inclusivity. The effects of supervisor trust on residents fell into three themes: learning experiences, attitudes and self-confidence, and identities and roles. Optimal trust supported learning via tailored guidance, confidence and lessened vulnerability, and a sense of patient ownership and team belonging. Discussion Understanding how trainees recognize supervisor trust can enhance interventions for improving the dialogue of trust between supervisors and trainees. It is important for supervisors to be cognizant of their trainees’ interpretations of trust because it affects how trainees understand their patient care roles, perceive autonomy, and approach learning.

Trainees' perceptions of being allowed to fail in clinical training: A sense‐making model

“…This may threaten the mutual trust between trainees and supervisors, which is fostered by open and honest learning conversations. 23 In terms of debriefing, our results suggest that supervisors currently approach debriefing conversations in a technical manner focused on solution and prevention. This narrow focus should be expanded to include the emotions of experienced failure as this seems to be a crucial component of perceived learning.…”

“…With a trusting relationship between supervisor and trainee, trainees are more likely to admit their failures and supervisors are more likely to give trainees the autonomy they need to stretch themselves. [23][24][25] How supervisors respond to trainee failures can either mitigate or intensify emotional consequences such as guilt and shame 12,17 and has implications for progression, as supervisors judge whether to entrust the trainee in the current, and future, clinical situations. Such judgements are a dynamic supervisory process 26,27 that requires evidence not only that the trainee is competent to perform independently, but also that they have an awareness of their own limits and a likelihood of asking for help when they need it.…”

“…6,26,[28][29][30] In addition to such trainee dependent factors shaping entrustment decisions, other factors such as contextual circumstances and the acquaintance and relationship of the supervisor and the trainee also play a critical role. [23][24][25][26]31 Into this rich scholarly conversation about trainee failure, clinical supervision, and entrustment decisions, recent studies added the insight that supervisors sometimes strategically allow failure when they judge that it would support training learning. 32,33 Based on interviews with clinical supervisors, the phenomenon of allowing failure was defined as a situation in which, "while supervising a trainee's clinical performance, the supervisor, influenced by both intuition and a non-linear interplay of different factors, detects an imminent trainee mistake, has the opportunity to intervene but chooses not to do so, because the educational gain for the trainee is perceived to outweigh the (potential) consequences for the patient."…”

Supervising the senior medical resident: Entrusting the role, supporting the tasks

“…It is also unknown whether being aware of this judgement would be helpful as a form of feedback to the resident or if it could lead to unintended consequences, such as emphasising a performance orientation 22 . Early research suggests that even if supervisors are not explicit about their entrustment, residents make judgements of their supervisor's trust in them through the patients they are allowed to see and the work they are allowed to do 23 …”

“…22 Early research suggests that even if supervisors are not explicit about their entrustment, residents make judgements of their supervisor's trust in them through the patients they are allowed to see and the work they are allowed to do. 23…”