Thirty years of Night Medicine In Graduate Medical Education

Abstract

Residency programs are arduous and rigorously structured surrounding active patient care management. Residency years are formative years for physician's career. Gaining trust and autonomy from supervising physicians for their actions is critical to be an effective team member and gaining clinical experience and education. . Entrusting a resident with critical actions and behaviors shapes their competency and judgments. Becoming a competent practicing physician requires clinical problem solving and judgment during training years. Residents are negatively impacted by a lack of trust in their skills, autonomy, and a blurred sense of accountability in current teamwork environment. Entrustment is necessary for a trainee to begin to practice autonomously and be accountable for their actions and decisions. The complex interplay between trust, autonomy, and accountability during clinical training allows them to become highly motivated, develop competency, independently manage their patients, become autonomous learners and teachers, and deliver effective patient care.Supervising physician trust in a resident implies a personal judgment in the outcome of the resident's future performance. Trust is not an observed ability; rather, it is a "gut feeling" that may not always match up for formally assessed knowledge or skill. Entrustment require selfcontrol, masterful inactivity and watchful expectancy in his/her resident. This style of supervision gives the resident psychological, emotional and cognitive safety and create nurturing learning environment. The residency programs should strive to provide optimal balance between trust, accountability and autonomy with best patient safety. This trust become more evident during the night medicine or night time duties for residents when supervising physicians are not always available for immediate supervision.

Micromanagement During Clinical Supervision: Solutions to the Challenges

“…The right balance between learner autonomy and supervision is ideal for critical thinking and self-reflection [ 22 ]. When learners are given autonomy, they are motivated to be accountable for the patient, an attitude that is vital in effective clinical practice [ 23 ]. Studies of students given autonomy revealed an associated increase in intrinsic motivation, as well as a desire to learn and take on challenges [ 18 ].…”

“…Patient care should always be prioritized, and supervising attendings should “adjust their level of supervision”, depending on the level of urgency for critical action and trainee competence [ 20 ]. Therefore, residency programs ideally should have a balance between trust, accountability, and autonomy while still prioritizing patient care and safety [ 23 ].…”