E.W. Pingree is instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
K. Huth is instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Acad Med. 2020 Nov;95(11):1718-1725. doi: 10.1097/ACM.0000000000003487.
To explore resident and attending physician perceptions of resident behaviors and skills that demonstrate trustworthiness and promote entrustment by supervisors.
Using grounded theory methodology, the authors conducted 3 focus groups with pediatric residents from the Boston Combined Residency Program and 3 focus groups with attending physicians who were either general pediatric hospitalists or other pediatric subspecialists at Boston Children's Hospital and Boston Medical Center in Boston, Massachusetts, from May to December 2018. Data were collected and analyzed iteratively until theoretical saturation was achieved. Three independent reviewers coded each transcript. Codes were grouped into dominant themes to develop a conceptual model.
Twelve residents and 18 attending physicians participated in the focus groups. Participants described actions that they felt actively demonstrated residents' trustworthiness within previously described domains of trustworthiness. Four modifiers emerged that affect a resident's progression from trustworthiness to entrustment: (1) self-management, (2) relationships, (3) self-advocacy, and (4) patient-centeredness. Findings were synthesized into a conceptual model depicting how trainees can promote their own entrustment by supervisors.
Trainees must actively demonstrate their trustworthiness to be entrusted. This study proposes that trainees can further gain entrustment through self-management, relationships, self-advocacy, and patient-centeredness. When they understand the actions and behaviors that promote entrustment, trainees may be better able to foster autonomy and progress toward more independent clinical practice. These findings add to existing evidence regarding entrustment and provide a novel, actionable framework for trainees to increase their own entrustment.
探讨住院医师和主治医生对住院医师表现出值得信赖并促进主管医生委托的行为和技能的看法。
作者使用扎根理论方法，于 2018 年 5 月至 12 月在马萨诸塞州波士顿的波士顿联合住院医师计划中对儿科住院医师进行了 3 次焦点小组讨论，并对波士顿儿童医院和波士顿医疗中心的普通儿科医院医生或其他儿科亚专科医生的 3 次主治医生焦点小组进行了 3 次焦点小组讨论。数据是通过迭代收集和分析的，直到达到理论饱和。三位独立评审员对每份抄本进行编码。将代码分组为主要主题，以开发概念模型。
12 名住院医师和 18 名主治医生参加了焦点小组。参与者描述了他们认为在先前描述的值得信赖的领域内积极展示住院医师值得信赖的行为。出现了四个修饰符，它们影响着从值得信赖到委托的住院医师的进展：（1）自我管理，（2）人际关系，（3）自我倡导，（4）以患者为中心。研究结果综合成一个概念模型，描述了学员如何通过主管医生的自我管理，人际关系，自我倡导和以患者为中心来促进自己的委托。
住院医师必须积极表现出值得信赖才能被委托。本研究表明，通过自我管理，人际关系，自我倡导和以患者为中心，住院医师可以进一步获得委托。当他们了解促进委托的行为和行为时，住院医师可能会更好地培养自主性并朝着更独立的临床实践迈进。这些发现增加了有关委托的现有证据，并为学员提供了一个新颖的，可操作的框架，以增加他们自己的委托。
