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:
Image
3/ So what are entrustment & empowerment, and why do they matter in #MedEd?

The article below in @AcadMedJournal provides a helpful definition of entrustment:
journals.lww.com/academicmedici…

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.
hbr.org/2018/03/when-e…

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:
1⃣Supervisor
2⃣Trainee
3⃣Trainee-supervisor relationship
4⃣Task/activity
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
journals.lww.com/academicmedici…

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:
journals.lww.com/academicmedici…

TL;DR:
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:
*⃣Feedback
*⃣Asking questions
*⃣Mini-teaching

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*
#Sepsis
- 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.
 
pubmed.ncbi.nlm.nih.gov/34348389/
 
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!

Image
Read 15 tweets

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