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Shim S, Kim H, Lee YM. Scoping review: exploring residents' views of supervisor entrustment and its effect on learning and professional development. KOREAN JOURNAL OF MEDICAL EDUCATION 2024; 36:81-98. [PMID: 38462244 PMCID: PMC10925806 DOI: 10.3946/kjme.2024.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 03/12/2024]
Abstract
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.
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Affiliation(s)
- Sunhee Shim
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
| | | | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul, Korea
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Stoeckl EM, Garren ME, Nishii A, Evans J, Minter RM, Sandhu G, Jung SA. TrustEd: A Tool for Developing Intraoperative Entrustment Skills. JOURNAL OF SURGICAL EDUCATION 2022; 79:574-578. [PMID: 34972669 DOI: 10.1016/j.jsurg.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Toolkits to assess progressive resident autonomy are integral to the movement toward competency-based surgical education. OpTrust is one such tool validated for intraoperative assessment of both faculty and resident entrustment behaviors. We developed a supplementary tool to OpTrust that would aid faculty and residents in making meaningful improvements in entrustment behavior by providing talking points and reflection items tailored to different motivational styles as defined by Regulatory Focus Theory (RFT). DESIGN Existing literature about surgical entrustment was used to build a list of sample dialogue and self-reflection items to use in the operating room. This list was distributed as a survey to individuals familiar with OpTrust and RFT, asking them to categorize each item as Promotion-oriented, Prevention-oriented, or Either. The respondents then met to discuss survey items that did not reach a consensus until the group agreed on their categorization. SETTING University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin Michigan Medicine, Ann Arbor, Michigan PARTICIPANTS: Clinician and education researchers familiar with intraoperative entrustment and RFT RESULTS: Eight respondents completed the survey categorizing the talking points and reflection items by RFT (100% response rate). Six of these respondents attended the additional meeting to discuss discordant items. The input from this panel was used to develop "TrustEd," the supplementary tool that faculty and residents can quickly reference before beginning a case. CONCLUSION Although tools such as OpTrust allow intraoperative entrustment behaviors to be quantified, TrustEd offers concrete strategies for faculty and residents who are interested in improving those behaviors over time. Further study is needed to assess whether the use of TrustEd does in fact lead to durable behavior change and improvement in OpTrust scores.
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Affiliation(s)
- Elizabeth M Stoeckl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Margaret E Garren
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Akira Nishii
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Julie Evans
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Rebecca M Minter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sarah A Jung
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Woelfel IA, Smith BQ, Salani R, Harzman AE, Cochran AL, Chen X(P. The long game: Evolution of clinical decision making throughout residency and fellowship. Am J Surg 2022; 223:266-272. [PMID: 33752873 PMCID: PMC9045150 DOI: 10.1016/j.amjsurg.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to explore the trajectory of autonomy in clinical decision making. METHODS We conducted a qualitative secondary analysis of interviews with 45 residents and fellows from the General Surgery and Obstetrics & Gynecology departments across all clinical postgraduate years (PGY) using convenience sampling. Each interview was recorded, transcribed and iteratively analyzed using a framework method. RESULTS A total of 16 junior residents, 22 senior residents and 7 fellows participated in 12 original interviews. Early in training residents take their abstract ideas about disease processes and make them concrete in their applications to patient care. A transitional stage follows in which residents apply concepts to concrete patient care. Chief residents re-abstract their concrete technical and clinical knowledge to prepare for future surgical practice. CONCLUSIONS Understanding where each learner is on this pathway will assist development of curriculum that fosters resident readiness for practice at each PGY level.
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Affiliation(s)
- Ingrid A. Woelfel
- Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA,Corresponding author. Department of Surgery, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA. (I.A. Woelfel)
| | - Brentley Q. Smith
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, The Ohio State University, Starling-Loving Hall, 320 West 10th Ave, Columbus, OH, 43210, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, The Ohio State University, Starling-Loving Hall, 320 West 10th Ave, Columbus, OH, 43210, USA
| | - Alan E. Harzman
- Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA
| | - Amalia L. Cochran
- Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA
| | - Xiaodong (Phoenix) Chen
- Department of Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43201, USA
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Eskander MF, Woelfel I, Harzman A, Cochran AL, Ellison EC, Phoenix Chen X. Education Morbidity and Mortality: Reviving Intraoperative Teaching and Learning. J Surg Res 2021; 264:462-468. [PMID: 33848846 DOI: 10.1016/j.jss.2021.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/08/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Using the platform of morbidity and mortality conference, we developed and executed a combined faculty-resident intervention called "Education M&M" to discuss challenges faced by both parties in the operating room (OR), identify realistic solutions, and implement action plans. This study aimed to investigate the impact of this intervention on resident OR training. MATERIALS AND METHODS Two resident case presentations were followed by audience discussion and recommendations regarding actionable solutions aimed at improving resident OR training from an expert faculty panel. Postintervention surveys were completed by participants immediately and 2 mo later to assess perceived short and long-term impact on OR teaching and/or learning and the execution of two recommended solutions. Descriptive statistical analysis was applied. RESULTS Immediate post-intervention surveys (n = 44) indicated that 81.8% of participants enjoyed the M&M "a lot"; 90.1% said they would use some or a lot of the ideas presented. Awareness of OR teaching/learning challenges before and after the M&M improved from 3.0 to 3.7 (P = 0.00001) for faculty and 3.0 to 3.9 for trainees (P = 0.00004). Understanding of OR teaching and/or learning approaches improved from 3.1 to 3.7 for faculty (P = 0.00004) and 2.7 to 3.9 for trainees (P = 0.00001). In 2-mo post-intervention surveys, most residents had experienced two recommended solutions (71% and 88%) in the OR, but self-reported changes to faculty behavior did not reach statistical significance. CONCLUSIONS A department-wide education M&M could be an effective approach to enhance mutual communication between faculty members and residents around OR teaching/learning by identifying program-specific challenges and potential actionable solutions.
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Affiliation(s)
| | - Ingrid Woelfel
- Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Alan Harzman
- Ohio State University Wexner Medical Center, Columbus, Ohio
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Cassidy DJ, McKinley SK, Ogunmuyiwa J, Mullen JT, Phitayakorn R, Petrusa E, Kim MJ. Surgical autonomy: A resident perspective and the balance of teacher development with operative independence. Am J Surg 2021; 221:336-344. [DOI: 10.1016/j.amjsurg.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/05/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
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Hall AK, Nousiainen MT, Campisi P, Dagnone JD, Frank JR, Kroeker KI, Brzezina S, Purdy E, Oswald A. Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic. MEDICAL TEACHER 2020; 42:756-761. [PMID: 32450049 DOI: 10.1080/0142159x.2020.1766669] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic has disrupted healthcare systems around the world, impacting how we deliver medical education. The normal day-to-day routines have been altered for a number of reasons, including changes to scheduled training rotations, physical distancing requirements, trainee redeployment, and heightened level of concern. Medical educators will likely need to adapt their programs to maximize learning, maintain effective care delivery, and ensure competent graduates. Along with a continued focus on learner/faculty wellness, medical educators will have to optimize existing training experiences, adapt those that are no longer viable, employ new technologies, and be flexible when assessing competencies. These practical tips offer guidance on how to adapt medical education programs within the constraints of the pandemic landscape, stressing the need for communication, innovation, collaboration, flexibility, and planning within the era of competency-based medical education.
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Affiliation(s)
- Andrew K Hall
- Department of Emergency Medicine, Queen's University, Kingston, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | - Paolo Campisi
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - J Damon Dagnone
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Jason R Frank
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Karen I Kroeker
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | - Eve Purdy
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- Department of Medicine, University of Alberta, Edmonton, Canada
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Fuller S, Vaporciyan A, Dearani JA, Stulak JM, Romano JC. COVID-19 Disruption in Cardiothoracic Surgical Training: An Opportunity to Enhance Education. Ann Thorac Surg 2020; 110:1443-1446. [PMID: 32497642 PMCID: PMC7262527 DOI: 10.1016/j.athoracsur.2020.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Stephanie Fuller
- Division of Cardiothoracic Surgery, the Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan
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