#KeyLIMEPodcast Episode 100!!!: Do you trust your trainee?

The Key Literature in Medical Education podcast this week achieves a BIG milestone: Episode ONE HUNDRED.

It’s hard to believe that four years have passed!  The first episode, which was released January 17, 2012, was recorded in a hotel in Riyadh using a digital tape recorder. Over time, the technology has improved (Yeti mics, Garage band, and Uber Conference), while the locale has definitely deteriorated (my basement closet to minimize background noise).

The episode this week revisits the theme of trust between teacher and learner.  Previous podcasts have touched on this topic (Here and here).

We’ve also covered this on the blog (See post here).

As per usual, the summary abstract follows.  However, the real details can be found on the podcast here.

As we celebrate our centennial… Thanks for Listening!

– Jonathan (@sherbino)


KeyLIME Session 100 – Article under review:

Listen to the podcast

View/download the abstract here.

Fri post_KeyLIMEHauer KE, Oza SK, Kogan JR, Stankiewicz CA, Stenfors-Hayes T, Cate OT, Batt J, O’Sullivan PS. How clinical supervisors develop trust in their trainees: a qualitative study. Medical Education. 2015 Aug;49 (8):783-95

Reviewer: Jason R. Frank




Trust is the gateway to workplace participation in medical education, and thus acquisition of expertise.

Clinical supervision, the oversight by responsible clinical teachers of trainees’ work, is essential to health professions education. The contemporary ideal of supervision involves tailoring the degree of oversight to the level of expertise of the learner: more junior learners need closer supervision, and more senior learners need more autonomy. Making decisions about how to supervise a given trainee is a matter of trust: each supervisor everyday undertakes a process to answer the question: “How much can I trust this trainee to take care of patient care?”

The authors operationalize trust as:

Trust entails ‘dependence on something future’ and to entrust an individual with something is to ‘assign a responsibility to or put something into someone’s care’.

There is already a great deal of exciting work in this area by authors such as Hauer, ten Cate, Scheele, Kennedy & Regehr.

Previously identified factors that seem to be important include:
• Trainee’s apparent competence level
• Trainee’s conscientiousness & honesty
• Trainee’s help-seeking behaviour
• Trainee’s self-efficacy
• Supervisor’s apparent competence level
• Supervisor’s inclination to trust
• Supervisor’s supervisory ability
• Relationship between trainee & supervisor
• Local environment in terms of culture

Hauer & ten Cate return to this subject in this paper, in which they explore the ways supervisors develop trust in their trainees.

Type of Paper
Research: Qualitative

Key Points on the Method
This is a classic qualitative phenomenology paper (focused on individuals’ “lived experience of a phenomenon”). Participants were recruited with a $15 coffee card from a convenience sample of Internal Medicine attending physicians at 2 large academic hospitals who had supervised residents recently. Each was interviewed using a semi-structured design, including sensitizing concepts from the literature, by a research assistant. Interviews were transcribed and analyzed via coding in real time until saturation (aka “sufficiency”) was achieved. The analysis is pretty well described, reflexivity was addressed in the subject selection, triangulation methods, and iterative validity checking. Reflexivity of the PI wasn’t addressed explicitly.

Key Conclusions
The authors conclude that the development of supervisor trust of a clinical trainee is complex and multifaceted.

Spare Keys – other take home points for clinician educators

1. This is a beautiful example of model development for a phenomenon in MedEd
2. This is a good example of a phenomenology paper
3. Don’t forget the first author’s reflexivity

Access KeyLIME podcast archives here