Jonathan S Ilgen1, Anique B H de Bruin, Pim W Teunissen, Jonathan Sherbino, Glenn Regehr. 1. J.S. Ilgen is associate professor, Department of Emergency Medicine, University of Washington, Seattle, Washington, and PhD candidate, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0003-4590-6570. A.B.H. de Bruin is professor, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0001-5178-0287. P.W. Teunissen is professor, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and maternal fetal medicine specialist, Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0002-0930-0048. J. Sherbino is professor, Division of Emergency Medicine, Department of Medicine, and assistant dean, McMaster Education Research, Innovation and Theory (MERIT) program, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada; ORCID: http://orcid.org/0000-0003-0344-8057. G. Regehr is professor, Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada. ORCID: http://orcid.org/0000-0002-3144-331X.
Abstract
PURPOSE: Safe and effective supervised practice requires a negotiated partnership between trainees and their supervisors. Substantial work has explored how supervisors make judgments about trainees' readiness to safely engage in critical professional activities, yet less is known about how trainees leverage the support of supervisors when they perceive themselves to be at the limits of their abilities. The purpose of this study is to explore how trainees use supervisory support to navigate experiences of clinical uncertainty. METHOD: Using a constructivist grounded theory approach, the authors explored how novice emergency medicine trainees conceptualized the role of their supervisors during experiences of clinical uncertainty. They employed a critical incident technique to elicit stories from participants immediately following clinical shifts between July and September 2020, and asked participants to describe their experiences of uncertainty within the context of supervised practice. Using constant comparison, two investigators coded line-by-line and organized these stories into focused codes. The relationships between these codes were discussed by the research team, and this enabled us to theorize about the relationships between the emergent themes. RESULTS: Participants reported a strong desire for supported independence, where predictable and accessible supervisory structures enabled them to work semi-autonomously through challenging clinical situations. They described a process of borrowing their supervisors' comfort during moments of uncertainty and mechanisms to strategically broadcast their evolving understanding of a situation to implicitly invoke (the right level of) support from their supervisors. They also highlighted challenges they faced when they felt insufficiently supported. CONCLUSIONS: By borrowing comfort from-or deliberately projecting their thinking to-supervisors, trainees aimed to strike the appropriate balance between independence for the purposes of learning and support to ensure safety. Understanding these strategic efforts could help educators to better support trainees in their growth towards self-regulation.
PURPOSE: Safe and effective supervised practice requires a negotiated partnership between trainees and their supervisors. Substantial work has explored how supervisors make judgments about trainees' readiness to safely engage in critical professional activities, yet less is known about how trainees leverage the support of supervisors when they perceive themselves to be at the limits of their abilities. The purpose of this study is to explore how trainees use supervisory support to navigate experiences of clinical uncertainty. METHOD: Using a constructivist grounded theory approach, the authors explored how novice emergency medicine trainees conceptualized the role of their supervisors during experiences of clinical uncertainty. They employed a critical incident technique to elicit stories from participants immediately following clinical shifts between July and September 2020, and asked participants to describe their experiences of uncertainty within the context of supervised practice. Using constant comparison, two investigators coded line-by-line and organized these stories into focused codes. The relationships between these codes were discussed by the research team, and this enabled us to theorize about the relationships between the emergent themes. RESULTS:Participants reported a strong desire for supported independence, where predictable and accessible supervisory structures enabled them to work semi-autonomously through challenging clinical situations. They described a process of borrowing their supervisors' comfort during moments of uncertainty and mechanisms to strategically broadcast their evolving understanding of a situation to implicitly invoke (the right level of) support from their supervisors. They also highlighted challenges they faced when they felt insufficiently supported. CONCLUSIONS: By borrowing comfort from-or deliberately projecting their thinking to-supervisors, trainees aimed to strike the appropriate balance between independence for the purposes of learning and support to ensure safety. Understanding these strategic efforts could help educators to better support trainees in their growth towards self-regulation.