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Should Do or Could Do? Exploring How Trainees Make Sense of When Supervisors Change Their Proposed Clinical Approach.
Michael D Fishman1, Madhavi Muralidharan2, Sarah Cavallaro1
1Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
Summary
Trainees often avoid supervisor feedback on clinical approaches, missing learning opportunities. Educators should foster more supportive discussions about meaningful variations in medical training.
Area of Science:
- Medical Education
- Clinical Reasoning
- Qualitative Research
Background:
- Faculty feedback on trainee clinical encounters offers learning opportunities.
- Understanding how trainees process supervisor-initiated changes is crucial for effective medical education.
Purpose of the Study:
- To explore how emergency medicine trainees make sense of supervisor modifications to their clinical approaches.
- To develop a model explaining trainees' understanding of supervisor feedback.
Main Methods:
- Semistructured interviews with 16 senior emergency medicine residents.
- Analysis using constructivist grounded theory with meaningful variation as a framework.
Main Results:
- Trainees often preemptively adapted their approach to avoid feedback, viewing discussions as burdensome.
- Trainees differentiated between clinical (essential) and stylistic (optional) changes, investing more in understanding clinical ones.
- Attribution of change reasons was often done independently by trainees without supervisor input.
Conclusions:
- Trainees recognize the value of understanding feedback but often fail to engage supervisors in meaning-making.
- Missed opportunities for learning from meaningful variation highlight the need for more supportive feedback environments in training systems.
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