Trust and risk pitfalls in medical education: A qualitative study of clinical teachers

Abstract

Purpose Learning opportunities in teaching hospitals are gated by clinical teachers. One way to unpack their decision-making is to employ a ‘trust and risk’ model. This study aimed to uncover clinical teachers’ experience of trust, risk and vulnerability as they participate in medical education. Methods Hospital-based clinical teachers were interviewed about trust, risk and vulnerability in medical education. Data analysis was undertaken using a constructivist, qualitative framework. Results Twenty demographically diverse clinical teachers participated. Trust and risk were regarded as fundamental workplace and teaching concepts. Their concerns fell into three domains of risk: clinical, teaching and personal. Being trusted unlocked clinical learning opportunities, whereas trust failure limited future participation. Feeling trusted or not affected wellbeing and self-efficacy. Trust and risk pitfalls in education included bias, asymmetry and sidelining. Conclusions This study adds to the literature by voicing clinical teachers’ personal risks and vulnerabilities. Attention was drawn to the benefits of being perceived as trustworthy, and to the clinical, teaching and personal vulnerabilities of trust failure. If expert judgement of trustworthiness is to be legitimised as meaningful assessment, clinical teachers must be aware not only of how trust is built, but also the pitfalls of trust failure.