Shim Sunhee, Kim Hansea, Lee Young-Mee
Department of Medical Education, Korea University College of Medicine, Seoul, Korea.
Public Clinic, Cheongyang, Korea.
Korean J Med Educ. 2024 Mar;36(1):81-98. doi: 10.3946/kjme.2024.286. Epub 2024 Feb 28.
This scoping review aimed to systematically explore the complex and nuanced perceptions of residents entrusted with significant responsibilities by their supervisors in the clinical context. We conducted a comprehensive search strategy targeting six major electronic databases. Data were extracted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist and a scoping review protocol. Resident perceptions regarding entrustment and its impact on learning and professional development were categorized. This review elucidated the role of supervisor entrustment in shaping residents' clinical performance, notably influencing autonomy, self-confidence, responsibility for patients, learning needs and goals, uncertainty management, and professional identity formation. Residents identified factors that promote and hinder performance and entrustment development resulting from supervisor entrustment and distinguished between appropriate supervision and over- or under-supervision. Our review suggests that residents' perceptions of supervisor entrustment, as bestowed by supervisors, serves as a catalyst for enhancing autonomy, thereby exerting a significant influence on clinical performance, and fostering the development of a professional identity. However, residents' views on appropriate supervision differ in some ways from supervisors' perspectives. Further research is needed to bridge the gap between residents' expectations of autonomy and what they are given, and to explore the intricate relationship between autonomy and entrustment.
本范围综述旨在系统地探索临床环境中被上级赋予重大责任的住院医师的复杂而细微的认知。我们针对六个主要电子数据库开展了全面的检索策略。使用PRISMA-ScR(系统评价和Meta分析扩展版的范围综述首选报告项目)清单和范围综述方案提取数据。对住院医师关于委托及其对学习和职业发展的影响的认知进行了分类。本综述阐明了上级委托在塑造住院医师临床绩效方面的作用,尤其影响自主性、自信心、对患者的责任感、学习需求和目标、不确定性管理以及职业身份形成。住院医师确定了促进和阻碍上级委托导致的绩效和委托发展的因素,并区分了适当监督与过度或监督不足。我们的综述表明,住院医师对上级委托的认知,作为上级赋予的,是增强自主性的催化剂,从而对临床绩效产生重大影响,并促进职业身份的发展。然而,住院医师对适当监督的看法在某些方面与上级的观点不同。需要进一步研究来弥合住院医师对自主性的期望与他们所获得的自主性之间的差距,并探索自主性与委托之间的复杂关系。