Chang Yu-Che, Chuang Renee S, Hsiao Cheng-Ting, Khwepeya Madalitso, Nkambule Nothando S
Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Front Med (Lausanne). 2022 Jun 2;9:879271. doi: 10.3389/fmed.2022.879271. eCollection 2022.
Recent changes in medical education calls for a shift toward student-centered learning. Therefore, it is imperative that clinical educators transparently assess the work-readiness of their medical residents through entrustment-based supervision decisions toward independent practice. Similarly, it is critical that medical residents are vocal about the quality of supervision and feedback they receive. This study aimed to explore the factors that influence entrustment-based supervision decisions and feedback receptivity by establishing a general consensus among Taiwanese clinical educators and medical residents regarding entrustment decisions and feedback uptake, respectively.
In Q-methodology studies, a set of opinion statement (i.e., the Q-sample) is generated to represent the phenomenon of interest. To explore the factors that influence entrustment-based supervision decisions and feedback receptivity, a Q-sample was developed using a four-step approach: (1) literature search using electronic databases, such as PubMed and Google Scholar, and interviews with emergency clinical educators and medical residents to generate opinion statements, (2) thematic analysis and grouping using The Model of Trust, the Ready, Wiling, and Able model, and the theory of self-regulated learning, (3) translation, and (4) application of a Delphi technique, including two expert panels comprised of clinical educators and medical residents, to establish a consensus of the statements and validation for a subsequent Q-study.
A total of 585 and 1,039 statements from the literature search and interviews were extracted to populate the sample of statements (i.e., the concourse) regarding entrustment-based supervision decisions for clinical educators and feedback receptivity emergency medicine residents, respectively. Two expert panels were invited to participate in a Delphi Technique, comprised of 11 clinical educators and 13 medical residents. After two-rounds of a Delphi technique, the panel of clinical educators agreed on 54 statements on factors that influence entrustment-based supervision decisions and were categorized into five themes defined by the Model of Trust. Similarly, a total of 60 statements on the factors that influence feedback receptivity were retained by the panel of medical residents and were categorized into five themes defined by the Ready, Willing, and Able model and the theory of self-regulated learning.
Though not exhaustive, the key factors agreed upon by clinical educators and medical residents reflect the characteristics of entrustment-based supervision decisions and feedback receptivity across specialties. This study provides insight on an often overlooked issue of the paths to teaching and learning in competency-based residency training programs. Additionally, incorporation of the Delphi technique further adds to the existing literature and puts emphasis as an important tool that can be used in medical education to rigorously validate Q-statements and develop Q-samples in various specialties.
医学教育最近的变革要求向以学生为中心的学习转变。因此，临床教育工作者必须通过基于委托的监督决策来透明地评估其住院医师的工作准备情况，以实现独立执业。同样，住院医师积极表达他们所接受的监督和反馈的质量也至关重要。本研究旨在通过分别在台湾临床教育工作者和住院医师中就委托决策和反馈接受度达成普遍共识，探讨影响基于委托的监督决策和反馈接受度的因素。
在Q方法研究中，生成一组意见陈述（即Q样本）来代表感兴趣的现象。为了探讨影响基于委托的监督决策和反馈接受度的因素，采用四步法开发了一个Q样本：（1）使用电子数据库（如PubMed和谷歌学术）进行文献检索，并对急诊临床教育工作者和住院医师进行访谈以生成意见陈述；（2）使用信任模型、准备好、愿意且有能力模型和自我调节学习理论进行主题分析和分组；（3）翻译；（4）应用德尔菲技术，包括由临床教育工作者和住院医师组成的两个专家小组，以就陈述达成共识并为后续的Q研究进行验证。
分别从文献检索和访谈中提取了585条和1039条陈述，以构成关于临床教育工作者基于委托的监督决策和急诊医学住院医师反馈接受度的陈述样本（即全集）。邀请了两个专家小组参与德尔菲技术，其中一个由11名临床教育工作者组成，另一个由13名住院医师组成。经过两轮德尔菲技术，临床教育工作者小组就影响基于委托的监督决策的因素达成了54条陈述，并根据信任模型分为五个主题。同样，住院医师小组保留了总共60条关于影响反馈接受度的因素的陈述，并根据准备好、愿意且有能力模型和自我调节学习理论分为五个主题。
尽管并不详尽，但临床教育工作者和住院医师达成共识的关键因素反映了各专业基于委托的监督决策和反馈接受度的特点。本研究为基于能力的住院医师培训项目中一个经常被忽视的教学与学习路径问题提供了见解。此外，德尔菲技术的纳入进一步丰富了现有文献，并强调其作为医学教育中一种重要工具的作用，可用于严格验证Q陈述并在各个专业中开发Q样本。
