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Anna K. Brady, MD

Blogger: Anna K. Brady, MD

About the blogger: Anna Brady is an Assistant Professor at Oregon Health & Sciences University. She has a strong interest in graduate medical education, particularly procedural education. She completed the Teaching Scholars Program at the University of Washington during fellowship.

Citation: Sheu L, Kogan J, Hauer K. How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: a Qualitative Study. Acad Med. 2017;92:1320–1327.

Link: http://journals.lww.com/academicmedicine/Abstract/2017/09000/How_Supervisor_Experience_Influences_Trust,.34.aspx

Article: How Supervisor Experience Influences Trust, Supervision, and Trainee Learning: a Qualitative Study. 

Why this article? As a junior attending, I have been thinking a lot about how closely to supervise my learners in the ICU, the consult service, and the clinic. Recently, a senior colleague shared his own challenges in evaluating how closely to supervise trainees. This study, which describes a range of supervisory styles in both attending physicians and senior residents, really resonated with me. The authors interviewed PGY 2 and 3 internal medicine residents as well as attending physicians at two academic internal medicine residency programs, and they also interviewed trainees about their experiences with different types of supervisors. They describe four domains that contributed to supervisor's behaviors:

  1. Data - which aspects of the trainees' care the supervisor uses to grant trust
  2. Approach - how closely the supervisor personally monitors patient care provided by the trainees
  3. Perspective - what standard the supervisor compares his or her own behavior to (experiences as a learner or experiences as a supervisor)
  4. Clinical -  the supervisor's assessment of his or her own clinical skill 

Not surprisingly, early supervisors tended toward granular supervision and confirmation of task completion (i.e. "did you call that consult?") and checked in frequently with their trainees. However, experienced supervisors were not uniformly hands-off; a theme that emerged was that senior supervisors had learned when they needed to take a more granular approach (i.e. ensuring safe discharge).

The authors provide concrete examples of different supervisory styles and offer pros and cons of each, and it's clear there is not a one-size-fits-all approach. An important finding of the study is that trainees often felt they could not provide their attending physicians with feedback about the level of supervision provided. Given that there are downsides to both excessive and inadequate supervision, it's important that we as attending physicians consciously reflect on our supervisory styles to promote optimal learning and patient care.