How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis

Area of Science:

• Medical Education
• Physician Training
• Patient Safety

Background:

• Medical supervisors face challenges in evaluating trainee readiness for independent patient care.
• Understanding factors influencing trust is crucial for effective supervision and patient safety.

Purpose of the Study:

• To identify and describe factors influencing attending and resident physician perceptions of trust.
• To explore how these trust perceptions impact decision-making regarding trainee entrustment.

Main Methods:

• Qualitative study using the critical incident technique with internal medicine residents and attending physicians.
• Deductive qualitative analysis based on the entrustable professional activities framework.
• Calculation of inter-rater reliability using a generalized kappa statistic.

Main Results:

• 535 mentions of entrusting factors were identified, categorized into trainee, supervisor, task, and system domains.
• Trainee factors included confidence and specialty plans; supervisor factors included approachability.
• System factors like workload and situational characteristics also influenced entrustment decisions.

Conclusions:

• Trust in trainees is influenced by a complex interplay of trainee, supervisor, task, and environmental factors.
• Attending physicians use early interactions, language cues, and perceived trainee confidence to gauge trustworthiness.
• Trainee absences, even if regulated, can negatively impact attending physicians' willingness to entrust tasks.