Is “trust” the 2015 education concept of the year? It is certainly a popular theme on the ICE blog (Trust Me, KeyLIME 71: Using TRUST as a scale for assessment?). I’ve even been a co-investigator on a study that identifies trust as a key component of effective intraprofessional collaboration.
With CBME the emerging construct in health professional education, enTRUSTable professional activities (EPAs) are receiving considerable attention, as organizations (e.g. Accreditation Council of Graduate Medical Eduation, Royal College of Physicians & Surgeons of Canada etc.) emphasize progressive degrees of supervision in clinical learning enviroments. (e.g. wards, clinics, emergency departments).
The KeyLIME podcast this week examines the contributing factors that influence the complex dynamic of trust between learner and teacher. For details, see below. Or, download the podcast here.
KeyLIME Session 72 – Article under review:
View/download the abstract here.
Hauer KE, ten Cate O, Boscardin C, Irby DM, Iobst, W, O’Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace, Advances in Health Sciences Education (2014), 19 (3): 435-56
Reviewer: Jason Frank (@drjfrank)
Trust has increasingly been highlighted in recent years as an essential ingredient in clinical teaching and learning. It facilitates a trainee’s level of participation in clinical care. In this paper, Hauer and colleagues assert that trust “acts as a gatekeeper to the learner’s increasing level of participation and responsibility in the workplace.” However, trust is a concept that is difficult to pin down, define, and operationalize in the dynamic that is health professions education. How does it happen? What are the factors that impact it?
The authors set out to review the existing relevant literature describing trust in health professions education, and synthesize a model.
Type of paper
Narrative review & synthesis; Theory building
Key Points on the Methods
This is a narrative review, in which the authors searched the English-language publications in medical education, nursing, psychology, and business using MEDLINE, PsycINFO, Web of Science & CINAHL. They added additional articles via hand searches, bibliographies, and personal files. They excluded papers on trust that they deemed irrelevant to the supervisor-learner dynamic. No data on the search was provided.
The authors propose a model of the factors impacting trust in the clinical education
setting that involves a complex iteraction between the characteristics of the:
1. Supervisor (competence, confidence, assessment & teaching expertise, familiarity with context, propensity to trust, appropriate delegation, preparation for role, attitude to patient safety)
2. Learner (competence, experience, insight, habits, self-confidence, willingness to ask, collegiality, empathy, coping, feedback-seeking, personal accountability, ability to act autonomously)
3. Supervisor-Learner Relationship (rapport, social desirability vs. assessment, shared expectations, concordance, contact time)
4. Context (workplace dynamic, authentic role, resources, workload, culture, timing, dynamic team changes, opportunities for familiarity)
5. Task (sequencing, complexity, patient risk, guided participation, “right sizing”)
The authors conclude that the Hauer 5-Factor Model of Trust explains the nature of trust in clinical education. All educators must incorporate an understanding of these factors to correctly design and enhance teaching, learning, and assessment.
Spare Keys – other take home points for clinician educators
1. Every clinician-educator must have this paper in their library and the model described here in their head: it is a foundational perspective to clinical education’s complex dynamic
2. This is an outstanding example of a theory-building paper
3. The authors cite some really important bodies of work, including workplace learning by Stephen Billet, communities of practice by Lave & Wenger, and papers on the nature assessment reasoning by Shiphra Ginsberg, Jen Kogan, and Eric Holmboe. Every CE needs to be aware of these works.
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