Multiple role relationships in healthcare education.

Abstract

Healthcare training environments, particularly in multidisciplinary training settings, present unique ethical dilemmas as a result of the multiple relationships faculty must balance while working with trainees. The historical and current perspectives on multiple roles in training environments will first be summarized. Evidence of a gap between the extant discipline specific guidelines and the realities of situations that occur in healthcare training will then be revealed, as illustrated in a case example. Primary care medicine training environments are highly nuanced, potentially leading to an infinite number of ambiguous situations that require a generalizable model for managing multiple roles. Rather than recommend specific modifications to existing ethical guidelines, a new model emphasizing role awareness and decision making when challenges in healthcare training settings arise is proposed. Recommendations for the case example using the model are offered. All professionals are prone to boundary transgressions; explicit training about and the maintenance of appropriate role balance will help to ensure high-functioning relationships and maximize the quality of patient care, resident education, faculty and resident satisfaction, and modeling of professional behavior to improve competencies as clinicians and educators.

A systematic review of supervisory relationships in general practitioner training

“…However, these relationships must navigate numerous competing priorities and goals, balancing trainee educational support and autonomy, training programme and practice requirements, alongside patient safety. Such competing interests have been described as ubiquitous in health care supervisory settings . The results also suggested contextual threats to supervisory relationships, such as the clinical workload of the trainee and supervisor (which impacts on time for meaningful interaction), the documentation burden of postgraduate training and the risk that the supervisor's assessment role exaggerates the power imbalance in the relationship.…”

“…Disagreement or conflict in the relationship may occur if there are differing expectations of roles within supervision . Conflicting goals between trainee and supervisor were perceived to relate to decreased trainee confidence, inclusion in the practice and professional development …”

“…Such competing interests have been described as ubiquitous in health care supervisory settings. 56 The results also suggested contextual threats to supervisory relationships, such as the clinical workload of the trainee and supervisor (which impacts on time for meaningful interaction), the documentation burden of postgraduate training and the risk that the supervisor's assessment role exaggerates the power imbalance in the relationship.…”

Supervision of clinical assessment: The Multilevel Assessment Supervision and Training (MAST) approach

“…Group supervision provides the opportunity for discussions surrounding ethics and multiple relationships, as well as can facilitate disclosure of potential concerns before they arise. The consideration of these ethical issues presents another opportunity for the development and training of both beginning and advanced graduate students, as the possibility of multiple relationships may exist and are often unavoidable in health care settings (Reitz, Simmons, Runyan, Hodgson, & Carter-Henry, 2013).…”

Tensions in postgraduate training: Meaningful engagement or ‘tick‐box’ supervision?

“…[4][5][6] training relationships themselves also risk perfunctory, superficial and box-ticking approaches Tensions are ubiquitous in health care education, and not simply confined to the supervisor's roles. 11 There is a tendency within the medical profession to create narrow sets of uniform goals and expectations for how trainees are or 'ought' to be. 12 However, trainees have a number of responsibilities, both professionally and in their home and family life, which lead to diverse interpretations of what their training should look like and how the supervisory relationship can support it.…”