The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians

Abstract

Objectives Emergency medicine is a fast‐paced specialty that demands emergency physicians to respond to rapidly evolving patient presentations, while engaging in clinical supervision. Most research on supervisory roles has focused on the behaviors of attending physicians, including their individual preferences of supervision and level of entrustment of clinical tasks to trainees. However, less research has investigated how the clinical context (patient case complexity, workflow) influences clinical supervision. In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety. Methods Emergency physicians who regularly participated in clinical supervision in several academic teaching hospitals were individually interviewed using a semi‐structured format. The interviews were transcribed and analyzed using a constructivist grounded theory approach. Results Sixteen emergency physicians were asked to reflect on their clinical supervisory roles in the ED. We conceptualized a model that describes three prominent roles: teacher, assessor, and patient protector. Contextual features such as trainee competence, pace of the ED, patient complexity, and the culture of academic medicine influenced the extent to which certain roles were considered salient at any given time. Conclusions This conceptual model can inform researchers and medical educators about the role of context in accentuating or minimizing various roles of emergency physicians. Identifying how context interfaces with these roles may help design faculty development initiatives aimed to navigate the tension between urgent patient care and medical education for emergency physicians.

Exploring the use of rating scales with entrustment anchors in workplace‐based assessment

“…These in‐the‐moment decisions, or what ten Cate 34 refers to as ‘ad‐hoc entrustment’ decisions, are influenced by the factors such as trainee experience, past experiences working together and case complexity. Supervisory style may also play a role as supervisors balance patient care with trainee learning considering factors such as trainee competence, case complexity, trust and context 35,36 . Therefore, it seems the factors identified in this study, and others, influence the initial level of supervision provided to the trainee and the final WBA rating upon completion of the task.…”

Continuity of supervision: Does it mean what we think it means?

“…Others describe it as longitudinal but episodic , where supervision happens between the same supervisor(s) and learner periodically over a defined period of time 25 . In both continuous and episodic interpretations, the purpose of the supervisor(s) may be variable and can encompass one or more roles: teacher, assessor or patient protector 26 . This means that CoS has dimensions for learning, assessment and patient safety.…”

Purpose, Pleasure, Pace and Contrasting Perspectives: Teaching and Learning in the Emergency Department

“…Likewise, the ED context, such as trainee competence, pace of the ED, and patient complexity, may shape the ways in which EPs negotiate their competing roles as teacher, assessor, and patient protector. 12 The different perspectives of consultants and registrars within our data suggest that there is much work to be done in creating a productive educational community of practice in the ED. Wenger 23 describes communities of practice as requiring mutual engagement, joint enterprise, and shared resources.…”

“…While juggling significant and often critical care responsibilities in a busy environment EPs are expected to support and guide learning for their more junior colleagues. Li et al 12 describe three main roles of the ED clinician as teacher, assessor, and patient protector, which are influenced by context. We began our exploration of clinical teaching in the ED using the EFFECT tool (informed by the CanMEDS framework), which includes additional roles such as role modeling, planning, and support.…”

“…This suggests that EPs can facilitate learning for registrars in the midst of quite complex patient care interactions. Likewise, the ED context, such as trainee competence, pace of the ED, and patient complexity, may shape the ways in which EPs negotiate their competing roles as teacher, assessor, and patient protector 12 …”