How Residents Develop Trust in Interns

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Abstract

Although residents trust interns to provide patient care, little is known about how trust forms.

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Most cited references 29

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Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

Nigel King, Henny Boshuizen, Albert Scherpbier … (2006)

To develop a model linking the processes and outcomes of workplace learning. We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.

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Measuring trust inside organisations

Karin Sanders, Graham Dietz, Deanne Den Hartog (2006)

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When do supervising physicians decide to entrust residents with unsupervised tasks?

Cor Kalkman, Olle ten Cate, Paul Barach … (2010)

Patient-care responsibilities stimulate trainee learning but training may compromise patient safety. The authors investigated factors guiding clinical supervisors' decisions to trust residents with critical patient-care tasks. In a mixed quantitative and qualitative descriptive study carried out at University Medical Center Utrecht, Utrecht, the Netherlands, from March to September 2008, the authors surveyed attending anesthetists and resident anesthetists regarding when attendings should entrust each of six selected critical tasks to residents. The authors conducted structured interviews with both groups, using trigger case vignettes to solicit opinions on factors that affect entrustment decisions. Thirty-two attending anesthetists and 31 residents answered the questionnaire (response rate 58%), and 10 participants from each group were interviewed. Attendings varied in their opinions regarding how much independence to give residents, particularly postgraduate year (PGY) 2, 3, and 4 residents. PGY1 residents reported working above their expected level of competence but estimate their own ability as sufficient, whereas PGY5 residents reported working below their expected level of competence. The authors classified factors that determine entrustment into four groups: characteristics of the resident, the attending, the clinical context, and the critical task. Residents' and attendings' opinions and impressions differ regarding what is expected from residents, what residents actually do, and what residents think they can do safely. The authors list factors affecting why and when supervisors trust residents to proceed without supervision. Future studies should address drivers behind entrustment decisions, correlations with patient outcomes, and tools that enable faculty to justify their entrustment decisions.

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Author and article information

Journal

Title: Academic Medicine

Abbreviated Title: Academic Medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 1040-2446

Publication date Created: 2016

Publication date (Print): October 2016

Volume: 91

Issue: 10

Pages: 1406-1415

Article

DOI: 10.1097/ACM.0000000000001164

PubMed ID: 26983076

SO-VID: 770a7c89-d29b-4492-907d-c2212e147509

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How Residents Develop Trust in Interns : A Multi-Institutional Mixed-Methods Study

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Most cited references 29

Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

Measuring trust inside organisations

When do supervising physicians decide to entrust residents with unsupervised tasks?

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