Stroud Lynfa, Feilchenfeld Zachary, Piquette Dominique, Watling Chris, Miles Amy, Brydges Ryan, Ginsburg Shiphra
Department of Medicine and a centre researcher at the Wilson Centre for Education, University of Toronto, Sunnybrook HSC, Rm C412, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Interdepartmental Division of Critical Care Medicine and a centre researcher at the Wilson Centre for Education, University of Toronto, Toronto, ON, Canada.
Adv Health Sci Educ Theory Pract. 2025 Sep;30(4):1279-1296. doi: 10.1007/s10459-024-10396-2. Epub 2024 Dec 19.
Implementing competency based medical education (CBME) has generated enormous amounts of assessment data. To help residents synthesize and use these data, some programs have appointed academic advisors (AA) to 'coach over time'. This study explored how resident and faculty AA dyads perceived their relationship developing and evolving, and the extent to which it aligned with 'coaching over time'. Over a two-year period at four separate time-points, we conducted longitudinal qualitative interviews with nine dyads of Internal Medicine residents (32 interviews) and their paired AA (27). We used constructivist grounded theory to develop a conceptual understanding of how AA-resident relationships evolved. Three major themes were identified. 'Building the Relationship' included elements perceived to facilitate or impede growth of the relationship. Most relationships flourished, facilitated by passage of time, 'fit' between the two, and often by working together clinically. Still, many residents perceived the need to 'save face' with their AAs. 'Enacting the AA Role' had features that appeared to align more with mentorship than coaching. 'Finding Meaning in the Relationship' underscored the perceived value fostered by the longitudinal pairing. The relationships often, but not always, achieved far-reaching benefits, though not necessarily limited to those intended by the program. Our study helps us understand what 'coaching over time' might look like for large residency programs wherein residents rotate through many sites and services. The dyads created an opportunity for a coaching relationship to form and develop in beneficial ways, though it was different to and went beyond the narrower focus on meeting CBME requirements.
实施基于胜任力的医学教育（CBME）产生了大量的评估数据。为了帮助住院医师综合和利用这些数据，一些项目指定了学术顾问（AA）进行“长期指导”。本研究探讨了住院医师与担任学术顾问的教员如何看待他们的关系发展和演变，以及这种关系与“长期指导”的契合程度。在两年时间里，我们在四个不同的时间点，对九对内科住院医师（32次访谈）及其配对的学术顾问（27次访谈）进行了纵向定性访谈。我们运用建构主义扎根理论，对学术顾问 - 住院医师关系的演变形成概念性理解。确定了三个主要主题。“建立关系”包括被认为促进或阻碍关系发展的因素。大多数关系随着时间的推移、双方的“契合”以及临床合作而蓬勃发展。然而，许多住院医师认为有必要在学术顾问面前“保全面子”。“履行学术顾问角色”的特征似乎更符合指导而非辅导。“在关系中寻找意义”强调了纵向配对所带来的感知价值。这种关系常常（但并非总是）带来深远的益处，尽管不一定局限于项目预期的那些益处。我们的研究有助于我们理解，对于大型住院医师培训项目而言，其中住院医师会在多个地点和科室轮转，“长期指导”可能是什么样的。这种配对为以有益方式形成和发展辅导关系创造了机会，尽管它不同于且超越了更狭义的满足CBME要求的关注点。
