Jennifer Spicer, MD, MPH Profile picture
Sep 29, 2020 19 tweets 11 min read Read on X
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:… 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

Mar 17, 2023
Kicking off BST Mode ⁦@emoryimchiefs⁩ Grady campus on #MatchDay2023

Do you want a 4-step process for questions to ask when you get a page next year when you’re alone on nightfloat or ICU call?

Check out this framework! Image
And now, do you wanna remember who the heck to order DEXA scans for in clinic?

Thankfully Miko De Bruyn comes to the rescue. Image
Read 16 tweets
Mar 7, 2023
1/ You're seeing a new consult with your team, and you want to teach the primary team too.

But WHEN is the best time to teach them?

On the phone?
At the bedside?
In their team room?

And in the morning?
Or maybe the afternoon?

This week: Image
2/ Last week @VarunPhadke2 described all of the individuals whom we can teach during the day.

But when should we teach them?

Often we default to teaching on the phone when receiving the consult or giving recommendations, but there are other options too.
3/ This week we will discuss the pros & cons of those options.

With one caveat.

Often the best time to teach is the one most convenient to your team & the primary team, which depends on your local institution's workflow.

But let's explore some general principles to consider.
Read 15 tweets
Feb 21, 2023
1/ You're finishing your last consult of the day.

It's late.
And it's been a long day.

You intended to find the primary team to teach them, but you have a million other things on your "to do" list.

Here are 8 reasons why you should still find time to teach the primary team. Image
2/ Reason #1: They want to learn

The primary team called with a question.
They are invested in the answer.

It's all about finding out what they want to know and targeting your teaching accordingly.
3/ Reason #2: It empowers them

Often the primary team has an idea of what to do but wants reinforcement that their plan is correct.

Teach them general rules that they can re-use. Image
Read 12 tweets
Jan 31, 2023
1/ Your team just saw a patient with syphilis, and you're ready to teach, but:

Resident #1: on week 2 of their rotation
👉 Has already seen 2 patients w/ syphilis

Resident #2: started today
👉 Hasn't seen a single patient with syphilis

What should you do now? Image
2/ Unfortunately, learners on our team may miss teaching that occurs during the rotation for multiple reasons. Image
3/ As @VarunPhadke2 previously pointed out, all learners on the team are usually not present all day, every day for the entire time we are on clinical services.

Read 16 tweets
Jan 24, 2023
1/ A member of your consult team presents a patient w/ suspected neurosyphilis.

Your team:
⭐️ 3rd year medical student
⭐️ IM intern
⭐️ 2nd year IM resident
⭐️ 1st year ID fellow

How can you possibly provide valuable teaching to all of them?

This week: Multi-level teaching Image
2/ Teaching multi-level learners is hard.

Their range in baseline knowledge means a single teaching point is often not effective for everyone.

So how can you support everyone's learning without taking too long and/or boring others?
3/ A prior thread discussed the importance of clarifying learners' needs & interests at the beginning of the rotation.

This is one 🗝️ for effective multi-level teaching.

Know what materials is RELEVANT and INTERESTING for each learner level.

Read 14 tweets
Jan 10, 2023
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

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