#KeyLIMEPodcast 328: Goldilocks and the 3 Trusts (of Supervisors)

Jason presents a study that looks to understand how residents recognize supervisor trust, as well as explore the effects of residents’ perceptions of supervisor trust on their learning and patient care.

Listen here to hear about the results of their study.


KeyLIME Session 328

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Gin et. al., 2021. How supervisor trust affects early residents’ learning and patient care: A qualitative study  Perspect Med Educ. Jul 23. doi: 10.1007/s40037-021-00674-9. Online ahead of print.


Jason R. Frank (@drjfrank)


If there is a Secret Sauce for effective clinical education, it likely includes the power of a special relationship between a clinician-teacher and a trainee. Thinking back to your own formative educational experiences, you can probably list some outstanding and some cringy examples of those supervisor-learner dyads. Did you feel supported? Did you feel welcomed into the team? Did you feel like no one would notice when you just left and went for noodles?

It seems that one of the magic words is “trust”. Trust operates through the teacher-learner relationship to mediate the learning environment in a variety of ways, including determining the kinds of opportunities given to learners and the nature of the supervision.

There is a huge body of literature looking at the ingredients of that special clinical environment. Some of that literature looks at the context; most of the studies look at the supervisors. What is missing is insights into how trust operates from the trainee perspective.


Enter Brian Gin and colleagues, including #meded guru Karen Hauer, all from UCSF in the US. They set out to:

  1. Understand how residents recognize supervisor trust, and
  2. Explore the effects of residents’ perceptions of supervisor trust on their learning and patient care.

The paper appears in the July 23, 2021 issue of Perspectives in MedEd. This work builds on a scholarly arc related to the topic of trust in the clinical education environment by Hauer’s group.

Key Points on the Methods

This is a qualitative study of junior Pediatrics residents at UCSF. The lead author was a Sr resident at the time of the study. 90 trainees in PGY1-2 were invited to participate. An interview guide was developed using critical incidents as an approach to enhance recall, and Hauer’s 5-factors of supervisor entrustment as a sensitizing framework. The interview guide was refined after pilots. The lead author conducted the interviews, which were recorded, transcribed, coded and analysed by the team. They used thematic analysis. There did not appear to be any participant checking.

There is an elegant reflexivity statement:

While we believe that our discussions were enriched by our representation of diverse stakeholder groups, we also strove to make inferences apart from these perspectives.

Key Outcomes

32 trainees volunteered. No new themes were identified after 21 interviews. Mean time in training was 3.5 months for PGY1s, and 19.6 for PGY2s. Participants were 81% women, reflecting the actual profile of the program.

Reminicent of Lara’s favourite fairy tale about Goldilocks and the 3 Bears, the authors coded themes according to optimal trust, under-trust, and over-trust.

Key Conclusions

The authors conclude that these themes provide insight into how trainees understand supervisor trust in the clinical environment. These findings should be used to guide faculty development and resident training to optimize clinical learning, particularly the autonomy-supervision balance. The language of the 5-factors of entrustment could help learners and teachers build effective trust.

Spare Keys – Other take home points for clinician educators

  1. This is a classic qualitative interview study using thematic analysis
  2. This is also a nice example of a scholarly arc building on a topic and elaborating on a phenomenon (in this case teacher-learner trust).

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