Sheu Leslie, Kogan Jennifer R, Hauer Karen E
L. Sheu is assistant professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. J.R. Kogan is professor of medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. K.E. Hauer is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
Acad Med. 2017 Sep;92(9):1320-1327. doi: 10.1097/ACM.0000000000001560.
Appropriate trust and supervision facilitate trainees' growth toward unsupervised practice. The authors investigated how supervisor experience influences trust, supervision, and subsequently trainee learning.
In a two-phase qualitative inductive content analysis, phase one entailed reviewing 44 internal medicine resident and attending supervisor interviews from two institutions (July 2013 to September 2014) for themes on how supervisor experience influences trust and supervision. Three supervisor exemplars (early, developing, experienced) were developed and shared in phase two focus groups at a single institution, wherein 23 trainees validated the exemplars and discussed how each impacted learning (November 2015).
Phase one: Four domains of trust and supervision varying with experience emerged: data, approach, perspective, clinical. Early supervisors were detail oriented and determined trust depending on task completion (data), were rule based (approach), drew on their experiences as trainees to guide supervision (perspective), and felt less confident clinically compared with more experienced supervisors (clinical). Experienced supervisors determined trust holistically (data), checked key aspects of patient care selectively and covertly (approach), reflected on individual experiences supervising (perspective), and felt comfortable managing clinical problems and gauging trainee abilities (clinical). Phase two: Trainees felt the exemplars reflected their experiences, described their preferences and learning needs shifting over time, and emphasized the importance of supervisor flexibility to match their learning needs.
With experience, supervisors differ in their approach to trust and supervision. Supervisors need to trust themselves before being able to trust others. Trainees perceive these differences and seek supervision approaches that align with their learning needs.
适当的信任和监督有助于实习生成长为能够独立执业的人员。作者研究了上级医生的经验如何影响信任、监督以及随后的实习生学习。
在两阶段定性归纳内容分析中，第一阶段需要回顾来自两个机构（2013年7月至2014年9月）的44次内科住院医生和上级医生的访谈，以找出上级医生经验如何影响信任和监督的主题。在第二阶段，在一个机构的焦点小组中提出并分享了三个上级医生范例（新手、成长中、经验丰富），23名实习生对这些范例进行了验证，并讨论了每个范例如何影响学习（2015年11月）。
第一阶段：出现了四个随经验而变化的信任和监督领域：数据、方法、观点、临床。新手上级医生注重细节，根据任务完成情况确定信任（数据），基于规则（方法），借鉴自己作为实习生的经验指导监督（观点），与经验更丰富的上级医生相比，临床信心较低（临床）。经验丰富的上级医生从整体上确定信任（数据），有选择地、隐蔽地检查患者护理的关键方面（方法），反思个人监督经验（观点），并且对处理临床问题和评估实习生能力感到得心应手（临床）。第二阶段：实习生认为这些范例反映了他们的经历，描述了他们的偏好和学习需求随时间的变化，并强调了上级医生灵活性以匹配他们学习需求的重要性。
随着经验的积累，上级医生在信任和监督方式上存在差异。上级医生需要先信任自己，才能信任他人。实习生察觉到这些差异，并寻求与他们学习需求相匹配的监督方式。
