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)
Trust or “entrustment” is essential, which is influenced by 5 factors:
1⃣Supervisor
2⃣Trainee
3⃣Trainee-supervisor relationship
4⃣Task/activity
5⃣Context
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
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
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
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
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.
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.
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
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.
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.
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!