Factors influencing novice supervisors' trust decisions in postgraduate family medicine training: a qualitative study

Trust is a foundational element in clinical supervision, influencing how and when autonomy is granted to postgraduate trainees. While prior research has largely focused on experienced supervisors, less is known about how novice supervisors navigate trust decisions.

This study aimed to explore how novice supervisors in postgraduate family medicine perceive trust and what factors influence their trust-building process.

In 2022-23, a qualitative descriptive study was conducted to examine trust formation among novice supervisors in a postgraduate family medicine training program in Saudi Arabia. Twenty supervisors with less than 5 years of supervisory experience were interviewed using semi-structured, one-on-one interviews. Data were analyzed using a framework analysis approach, guided by the model of trust formation.

Supervisors described trust as an evolving process shaped by cumulative observations, perceived clinical risk, and accountability. Initial interactions were characterized by high supervision and low trust, which adjusted over time through repeated exposure and relationship building. Institutional challenges such as short rotations, legal constraints, and high workloads often disrupted trust development, sometimes leading to superficial or "fake" entrustment. Supervisors with more clinical experience were more confident in calibrating trust, whereas less experienced supervisors often relied on cautious, checklist-style judgments.

Novice supervisors build trust incrementally through experience, observation, and relational engagement, but are often constrained by systemic and contextual barriers. Faculty development programs, structural supports and longer rotation periods may enhance trust calibration and enable safer, developmentally appropriate supervision.