1/ Supervisor's 💭
Why isn’t the heparin drip ordered yet? I’ll just order it...

Trainee's 💭
Why am I even here? My supervisor repeats everything I do. Do they even trust me?

How can we balance supervision w/ autonomy?

This week’s #MedEdTwagTeam topic: Trust & Empower
#MedEd Image
2/ This week’s discussion is our final @MedEdTwagTeam thread on foundational #ClinicalTeaching skills.

We discuss entrustment & empowerment, which are key to promoting *appropriate* autonomy.

If you missed @GStetsonMD’s thread last week, check it out:
3/ So what are entrustment & empowerment, and why do they matter in #MedEd?

The article below in @AcadMedJournal provides a helpful definition of entrustment:

When supervisors entrust trainees,
it empowers trainees.

It provides them with autonomy. Image
4/ And *appropriate* autonomy leads to meaningful work.

Empowerment motivates individuals, as outlined in this @HarvardBiz article.

But the key is identifying the *appropriate* level of autonomy.
That’s what we will discuss today.
5/ You may remember this image from @GStetsonMD last week based on Vygotsky’s zones of proximal development.

The key to entrustment & empowerment is:
✅identifying what our learners can do (allowing entrustment)
✅giving them with autonomy for those tasks (providing empowerment) Image
6/ Balancing supervision & oversight w/ learner autonomy & empowerment is complex.

Trust or “entrustment” is essential, which is influenced by 5 factors:
3⃣Trainee-supervisor relationship
5⃣Context Image
7/ Before getting going further, I want to emphasize that the “supervisor” can be anyone in a supervisory role:

Intern ➡️ medical student
Resident ➡️ intern
Fellow ➡️ resident
Attending ➡️ team

So let’s discuss some concrete things that all of us can do to entrust & empower.
8/ First, as a supervisor, we need to recognize that many factors influence our ability to trust.

*⃣Clinical experience
*⃣Experience with supervising others
*⃣Familiarity with clinical context/setting Image
9/ Supervisor experience, in particular, influences trust and supervision based on this qualitative study in @AcadMedJournal by @lesliesheu

In general, early supervisors provide less autonomy than experienced supervisors. Image
10/ So as supervisors, what can we do to entrust & empower our learners?

Observe your learners & “diagnose” where their current abilities lie within this framework. Image
11/ Here are some ways that we as supervisors can assess our learners including:

*⃣Direct patient care activities (e.g. taking a history
*⃣Proxies to patient care (e.g. listening to them present the history)

These assessments provide complementary information. Image
12/ And residents, remember that you are supervisors too!
All of these same rules apply.

This article in @AcadMedJournal by @lesliesheu specifically highlights how trust develops between residents & interns:

It’s similar
13/ Developing a strong relationship with learners helps.

And many of our prior #MedEdTwagTeam #TuesdayTweetorials provide tips that help build relationships.

Check out all of them here:
twitter.com/i/events/12908… Image
14/ But what can trainees do to encourage supervisors to trust them?

A number of things including:
*⃣Be honest/truthful
*⃣Be reliable/responsible
*⃣Recognize limitations & ask for help
*⃣Be open to feedback

And yes, clinical knowledge helps. But honestly, that’s less important Image
15/ Now lastly, it’s important to emphasize that the task & the context matter.

Here are some factors that impact entrustment:
✅Task: complexity, urgency, and patient risk
✅Context: resources, staffing, culture, hectic circumstances, time of day Image
16/ And remember that you want to give your learners the “right” amount of entrustment.

Too little: learners frustrated they aren’t empowered (“Why am I here?”)
Too much: learners frustrated b/c they fail (“I can’t do this”)

Just right: leads to learner satisfaction & meaning Image
17/ So, in summary, what can we do to entrust & empower out trainees?

We need to:
✅Set clear expectations
✅Observe & evaluate our learners
✅Provide clear feedback

And then consider how these 5 factors influence our entrustment decisions. Image
18/ This week’s discussion was our final @MedEdTwagTeam thread on the foundational #ClinicalTeaching skills.

Watch out for our future topics:
*⃣Asking questions

Check out the @MedEdTwagTeam to see all of our threads in one place!

Thanks for joining! Image

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More from @JenniferSpicer4

Jan 10
1/ *Re-consult 📞*

You: What did the last consult note say?

Them: I don't know how to interpret it...

*reading the ✍️ yourself*
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data

You: 🤦 I feel you... We'll see the patient again. Image
2/ You wonder...

💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?

And you're not the only one wondering...

How can we ✍️ more effective notes?
3/ Clinical notes are used for many purposes, as previously highlighted by @YihanYangMD

Read 15 tweets
Dec 13, 2022
1/ *Consult team room*

A brand-new learner joins your consult team.

You share details about a new consult & schedule ⏱️ to meet in the afternoon to staff.


5 minutes into their presentation you realize, "Oh no. I'm going to have to redo this consult, aren't I?"
2/ Learners on consult teams must tackle unfamiliar and complex questions, often with less time to evaluate a patient and develop a plan than on primary services.
3/ This @AcadMedJournal paper by @s_brond describes factors that contribute to cognitive load on consults.
Although this article focuses on the experiences of fellows, other learners likely struggle with some of these areas as well.
Read 16 tweets
Nov 15, 2022
1/ On a subspecialty team, we often have students & residents NOT going into our specialty...

...and then fellows who are trying to become experts.

How can we balance our teaching for everyone?

This week: Setting Learning Goals on Consult Teams Image
2/ First, I strongly believe in shared goal-setting, as described in this prior thread by @YihanYangMD

This process is especially important for learners who have CHOSEN the rotation as an elective. They likely have a particular learning need/interest!
3/ And if you have students or residents who are required to rotate in your specialty, shared goal-setting can increase motivation.

For these learners, I use their future career interest to set learning goals in addition to considering what they need to learn for boards.
Read 14 tweets
Nov 8, 2022
1/ Have you ever started your day with a great teaching plan...

...then by 12 pm, you've received consult 📟 #10:

"This patient has been hospitalized for 65 days & developed a 🌡️ 2 weeks ago..."

This week: balancing consults & teaching
(w/ principles for primary teams too!) Image
2/ Last week when we asked about your biggest challenge to teaching as a consultant, you answered:

#1: Time constraints
#2: Unpredictable workload

I feel this. This is what makes the day difficult to plan.

3/ Before I move forward, I want to mention some benefits I have that may not be universal:

1⃣ I minimize non-urgent meetings when on service
2⃣ I get some say re: when I'm on service to avoid overlapping with other commitments
3⃣ Our clinics are canceled when on service
Read 16 tweets
Oct 7, 2022
1/ Do you want to know tips & tricks for incorporating technology into teaching?

Here are the take home points from my presentation today at #iMed2022. Image
2/ First, remember that technology can *augment* teaching but can't replace good instructional design.

Just like a good stethoscope is helpful to hear a murmur but can't replace the skills and knowledge necessary to diagnose valvular dysfunction. Image
3/ So before you think about what technology to use, first think about:

*⃣ WHAT learners should able to do afterwards (i.e., learning objectives)
*⃣ HOW you should teach it to achieve your goals (i.e., teaching methods)

Then, and ONLY then, should you select a tech tool. Image
Read 12 tweets
Aug 23, 2022
1/ Are you a new resident, fellow, or attending trying to improve your inpatient teaching skills?

Then 👀 no further!

This week, the @MedEdTwagTeam ends a 3-week summary of our inpatient teaching 🧵 from the past year. Image
2/ This week we will summarize our content on how to do effective inpatient teaching after rounds – whether it’s a chalk talk or an afternoon discussion at the bedside. Image
3/ @YihanYangMD gave us some great examples of how she teaches during family meetings with some unique ways to involve the entire team in the experience!

Read 15 tweets

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