Exploring Complexity in Out-of-Hospital Clinical Supervision Using Rich Pictures

The rapidly evolving healthcare landscape in which physicians work and learn is becoming increasingly complex. This growing complexity presents challenges for supervisors and learners, who must balance autonomy with ensuring patient safety. The authors investigated how Elderly Care Medicine and General Practice trainees and supervisors perceive complexity in out-of-hospital settings. The results could contribute to improving the learning and supervision of trainees in complex situations.

From a constructivist paradigm, the authors applied "Rich Pictures" to explore participants' experiences. Via training institutions, participants were purposefully sampled until data were sufficient to answer the research question. Data collection took place through drawing of supervised complex care situations, directly followed by semi-structured interviews. The authors conducted a reflexive thematic analysis. They analyzed data iteratively, both individually and in "Gallery walks". Through consultation and discussion, consensus was reached.

Participants described complexity as an intricate interplay of multiple problems in multiple dimensions, where the network of various systems and stakeholders surrounding patients and their interactions and relationships have a major influence on how complexity is perceived. Human interaction was a significant contributor here. For trainees and supervisors, factors related to their working experience and the trainee-supervisor relationship could make a situation more complex.

While literature in the field of medical education on complexity mainly describes medical, psychosocial and intrasystemic elements, our findings indicate that intersystemic factors also contribute considerably to how trainees and supervisors in out-of-hospital settings perceive complexity. Recognizing this is an important first step to advance training in the workplace in out-of-hospital settings.