Sink or swim? The difficulty of finding the correct level of independence and support for trainees

You are in charge now: exploration of educational relationships between anaesthetic trainees and their supervising specialists

Background

Much of the education during anaesthesia training occurs in the workplace where trainees work under the close supervision of a more senior anaesthetist. Trainee anaesthetists are exposed to multiple supervisors with whom they form educational and supervisory relationships over the course of their training. Surprisingly little research has been conducted to explore the factors behind the development and maintenance of these relationships. This study explores the process of how education occurs in the workplace by examining the relationship from the perspective of both trainees and specialists.

Methods

This is an exploratory qualitative study. Eight trainee and 10 specialist anaesthetists participated in an individual semi-structured interview. The data were analysed thematically by each of the authors to generate themes.

Results

Six themes were identified in the analysis: (1) sizing up; (2) negotiated autonomy; (3) working closely together; (4) workplace practices; (5) education being valued; and (6) gender. A conceptual model to illustrate the relationships between the six themes was developed.

Conclusions

Supervisory relationships were viewed positively by participants despite impediments such as lack of continuity and busy clinical environments. But there were tensions, particularly in balancing trainee autonomy with patient safety. A nuanced 'sizing up' process, with negotiation of autonomy, was described by both supervisors and trainees. Our findings may support supervisory relationships to reach this ideal more effectively.

How postgraduate trainees from different health professions experience the learning climate within an operating theater: a mixed-methods study

BACKGROUND

The learning climate within a learning environment is a key factor to determine the potential quality of learning. There are different groups of postgraduate trainees who study primarily in the operating theater (OT), which is a complex, high-stake environment. This study created and validated an interprofessional measure of the OT educational climate and explored how postgraduate trainees from different health professions experienced the learning climate within the operating theater.

METHODS

An explanatory, sequential mixed-method design was used. The quantitative phase used and validated a newly developed questionnaire, the Operating Theater Educational Climate Test (OTECT), to evaluate the perceptions of anesthesia residents, surgical residents and student registered nurse anesthetists. In the qualitative phase, three mono-professional focus groups participants' opinions on the factors influencing their learning climate were explored.

RESULTS

The OTECT questionnaire was found to be valid. The questionnaire response rate was 78.9% (142 respondents from 180). Questionnaire results indicated similar perceptions of the OT learning climate by learners from all disciplines. Focus groups revealed three major influencing factors on the experienced learning climate: 1) nature of work in the OT, 2) the role of the supervisor, and 3) the interprofessional dimension of work in the OT.

CONCLUSIONS

The OT learning climate was perceived similarly by trainees from three health profession. The high stakes nature of the OT inhibited learning most as it impacted both trainees and supervisors. The results can be applied to improve the overall learning environment in the OT for all groups of learners.