Abstract
IntroductionTo advance in their clinical roles, residents must earn supervisors’ trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. However, trust in the continuity clinic setting, where resident roles, relationships, and context differ, is not well understood. We aimed to explore how preceptors in the continuity clinic setting develop trust in internal medicine residents and how trust influences supervision.MethodsIn this qualitative study, we conducted semi-structured interviews with faculty preceptors from two continuity clinic sites in an internal medicine residency program at an urban academic medical center in the United States from August 2018–June 2020. We analyzed transcripts using thematic analysis with sensitizing concepts related to the theoretical framework of the five factors of trust.ResultsSixteen preceptors participated. We identified four key drivers of trust and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships, 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors influencing supervision. Preceptors shared challenges to determining trust stemming from incomplete knowledge about patients and limited opportunities to directly observe and supervise between-visit care.DiscussionThe continuity clinic setting offers unique supports and challenges to trust development and trust-supervision alignment. Maximizing resident-preceptor-patient continuity, promoting direct observation, and improving preceptor supervision of residents’ provision of between-visit care may improve resident continuity clinic learning and patient care.Supplementary InformationThe online version of this article (10.1007/s40037-021-00694-5) contains supplementary material, which is available to authorized users.
Highlights
To advance in their clinical roles, residents must earn supervisors’ trust
This study aims to use the theoretical framework of the five factors that influence trust to explore how preceptors in continuity clinics develop trust in residents and how trust influences supervision [9]
We identified four key drivers of trust development and supervision in the continuity clinic setting: 1) longitudinal resident-preceptor-patient relationships 2) direct observations of continuity clinic skills, 3) resident attitude towards their primary care physician role, and 4) challenging context and task factors
Summary
To advance in their clinical roles, residents must earn supervisors’ trust. Research on supervisor trust in the inpatient setting has identified learner, supervisor, relationship, context, and task factors that influence trust. Supervision of resident trainees requires balance between ensuring safe, high-quality patient care and enabling learners to operate at the edge of their developmental level [1,2,3,4] Working with less supervision at the threshold of one’s competence can maximize learner growth [4,5,6] To advance in their clinical roles, resident learners must earn their supervisors’ trust. Medical education literature identifies five main factors influencing supervisors’ trust in trainees in the clinical setting: trainee, supervisor, trainee-supervisor relationship, context, and task [8, 9].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
