Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland.
Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Med Educ. 2023 May;57(5):430-439. doi: 10.1111/medu.14966. Epub 2022 Nov 21.
Clinical supervisors allow trainees to fail during clinical situations when trainee learning outweighs concerns for patient safety. Trainees perceive failure as both educationally valuable and emotionally draining; however, the nuance of supervised failures has not been researched from the trainee perspective. This study explored trainees' awareness and their experience of failure and allowed failure to understand those events in-depth.
We interviewed 15 postgraduate trainees from nine teaching sites in Europe and Canada. Participants were a purposive sample, representing 1-10 years of clinical training in various specialties. Consistent with constructivist grounded theory, data collection and analysis were iterative, supporting theoretical sampling to explore themes.
Trainees reported that failure was a common, valuable, and emotional experience. They perceived that supervisors allowed failure, but they reported never having it explicitly confirmed or discussed. Therefore, trainees tried to make sense of these events on their own. If they interpreted a failure as allowed by the supervisor, trainees sought to ascertain supervisory intentions. They described situations where they judged supervisor's intentions to be constructive or destructive.
Our results confirm that trainees perceive their failures as valuable learning opportunities. In the absence of explicit conversations with supervisors, trainees tried to make sense of failures themselves. When trainees judge that they have been allowed to fail, their interpretation of the event is coloured by their attribution of supervisor intentions. Perceived intentions might impact the educational benefit of the experience. In order to support trainees' sense-making, we suggest that supervisory conversations during and after failure events should use more explicit language to discuss failures and explain supervisory intentions.
临床主管允许学员在临床情况下犯错，只要学员的学习比患者安全更重要。学员认为失败既有教育价值，又让人情绪疲惫；然而，从学员的角度来看，监督下的失败的细微差别尚未被研究过。本研究从学员的角度探讨了他们对失败的认识和经验，并深入了解了这些事件。
我们采访了来自欧洲和加拿大九个教学基地的 15 名研究生学员。参与者是一个有目的的样本，代表了各个专业的 1-10 年的临床培训。与建构主义扎根理论一致，数据收集和分析是迭代的，支持理论抽样来探索主题。
学员们报告说，失败是一种常见、有价值且情绪化的体验。他们认为主管允许失败，但他们报告说，从未明确确认或讨论过。因此，学员们试图自己理解这些事件。如果他们将失败解释为得到主管的允许，学员们会试图确定主管的意图。他们描述了他们判断主管意图是建设性的还是破坏性的情况。
我们的结果证实，学员们认为他们的失败是有价值的学习机会。在没有与主管进行明确对话的情况下，学员们试图自己理解失败。当学员们判断他们被允许失败时，他们对事件的解释受到他们对主管意图的归因的影响。感知到的意图可能会影响经验的教育收益。为了支持学员的理解，我们建议在失败事件期间和之后的监督对话中应使用更明确的语言来讨论失败和解释监督意图。
