How supervisor trust affects early residents' learning and patient care: Aqualitative study.

Stephanie Tsoi,Karen E Hauer,Brian C Gin,Leslie Sheu

doi:10.1007/s40037-021-00674-9

Stephanie Tsoi, Karen E Hauer + Show 2 more

Open Access

https://doi.org/10.1007/s40037-021-00674-9

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Abstract

IntroductionTrust between supervisors and trainees mediates trainee participation and learning. A resident (postgraduate) trainee’s understanding of their supervisor’s trust can affect their perceptions of their patient care responsibilities, opportunities for learning, and overall growth as physicians. While the supervisor perspective of trust has been well studied, less is known about how resident trainees recognize supervisor trust and how it affects them.MethodsIn this qualitative study, 21 pediatric residents were interviewed at a single institution. Questions addressed their experiences during their first post-graduate year (PGY-1) on inpatient wards. Each interviewee was asked to describe three different patient care scenarios in which they perceived optimal, under-, and over-trust from their resident supervisor. Data were analyzed using thematic analysis.ResultsResidents recognized and interpreted their supervisor’s trust through four factors: supervisor, task, relationship, and context. Optimal trust was associated with supervision balancing supervisor availability and resident independence, tasks affording participation in decision-making, trusting relationships with supervisors, and a workplace fostering appropriate autonomy and team inclusivity. The effects of supervisor trust on residents fell into three themes: learning experiences, attitudes and self-confidence, and identities and roles. Optimal trust supported learning via tailored guidance, confidence and lessened vulnerability, and a sense of patient ownership and team belonging.DiscussionUnderstanding how trainees recognize supervisor trust can enhance interventions for improving the dialogue of trust between supervisors and trainees. It is important for supervisors to be cognizant of their trainees’ interpretations of trust because it affects how trainees understand their patient care roles, perceive autonomy, and approach learning.Supplementary InformationThe online version of this article (10.1007/s40037-021-00674-9) contains supplementary material, which is available to authorized users.

Highlights

Trust between supervisors and trainees mediates trainee participation and learning
It is important for supervisors to be cognizant of their trainees’ interpretations of trust because it affects how trainees understand their patient care roles, perceive autonomy, and approach learning
We grouped our results according to our two research questions: how trainees recognize supervisor trust and how trainees are affected by their perceptions of trust

Summary

Introduction

Trust between supervisors and trainees mediates trainee participation and learning. Studying resident trainees’ perspectives of entrustment revealed actionable ways for trainees to earn trust from their supervising attending physician [12]. A study of how residents manage clinical uncertainty revealed a role for trusting relationships in promoting residents’ autonomy and reciprocity of trust back to their supervisors [13]. This notion of mutual trust is thought to arise from early affective impressions, followed later by cognitive judgements from both supervisor and trainee viewpoints [14]

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