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It’s a matter of trust: exploring the basis of program directors’ decisions about whether to trust a resident to care for a loved one

  • Michelle H. YoonEmail author
  • Dina M. Kurzweil
  • Steven J. Durning
  • Deanna N. Schreiber-Gregory
  • Paul A. Hemmer
  • William R. Gilliland
  • Ting Dong
Article
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Abstract

There has been increased attention to and emphasis on competency-based medical education and the transformation from highly supervised medical students towards independent, entrustable physicians. We explored how program directors (PDs) justify decisions about whether they would trust finishing Post Graduate Year 1 (PGY1) residents to care for the PD or a loved one. Using an end of year survey with validity evidence, we assessed PDs’ responses (Yes, No, Not Sure) and written comments about this entrustment decision for USUHS medical students from graduating classes of 2013–2015 (PGY1). We performed a qualitative inductive content analysis to identify themes in how PDs justified their decisions as well as descriptive statistics and a contingency table analysis to examine associations between trust decisions and election to membership in Alpha Omega Alpha (AOA), or conversely, referral to the Student Promotions Committee (SPC) for remediation. Qualitative analyses revealed five themes related to this trust decision about medical residents: personal, interpersonal, knowledge, competence, and developmental. Neither AOA status, nor SPC referral status was significantly associated with the trust measure, overall, but positive trust decisions were significantly higher among those elected to AOA than in those who were not. Positive trust decisions were significantly associated with AOA status but negative trust decisions were not significantly associated with referral to the SPC. This study offers insights into what attributes may underpin trust decisions by PDs. Our findings suggest that PDs’ frequent use of personal and interpersonal characteristics to justify trust decisions contrasts with the use of clinical and knowledge based assessments during undergraduate medical education (UME), and emphasize the importance of critical intrinsic abilities.

Keywords

Professional trust Entrustability Graduate medical education Interns Residents 

Notes

References

  1. Alpha Omega Alpha Honor Medical Society Uniformed Services Chapter Bethesda, MD (n.d.) Retrieved September 10, 2017, from http://www.usuaoa.org/faq/.
  2. Andolsek, K. M. (2016). Improving the medical student performance evaluation to facilitate resident selection. Academic Medicine,91(11), 1475–1479.CrossRefGoogle Scholar
  3. Badyal, D. K., & Singh, T. (2017). Learning theories: The basics to learn in medical education. International Journal of Applied Basic Medical Research,7, S1–S3.CrossRefGoogle Scholar
  4. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  5. Borowitz, S. S., Saulsbury, F. T., & Wilson, W. G. (2000). Information collected during the residency match process does not predict clinical performance. Archives of Pediatric Adolescent Medicine,154(3), 256–260.CrossRefGoogle Scholar
  6. Boud, D. (1990). Assessment and the promotion of academic values. Studies in Higher Education,15(1), 101–111.CrossRefGoogle Scholar
  7. Bowen, G. A. (2008). Naturalistic inquiry and the saturation concept: A research note. Qualitative Research,8(1), 16.CrossRefGoogle Scholar
  8. Canterbury, R. J. (2016). Curriculum Inventory in Context—Effect of USMLE on U.S. Medical Education, 3(7). Washington, DC: Association of American Medical Colleges.Google Scholar
  9. Chickering, A. W., & Reisser, L. (1993). Education and identity (2nd ed.). San Francisco, CA: Jossey-Bass.Google Scholar
  10. Choo, K. J., Arora, V. M., Barach, P., Johnson, J. K., & Farnan, J. M. (2014). How do supervising physicians decide to entrust residents with unsupervised tasks? A qualitative analysis. Journal of Hospital Medicine,9(3), 169–175.CrossRefGoogle Scholar
  11. Creswell, J. W., & Plano-Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.Google Scholar
  12. Dong, T., Durning, S. J., Gilliland, W. R., Swygert, K. A., & Artino, A. R. (2015). Development and initial validation of a program director’s evaluation form for medical school graduates. Military Medicine,180(4), 7.Google Scholar
  13. Durning, S. J., Artino, A. R., Dong, T., Cruess, D. F., Gilliland, W. R., DeZee, K. J., et al. (2012). 40 years of military education: An overview of the long-term career outcome study (LTCOS). Military Medicine,177(Supplement 3), 3–6.CrossRefGoogle Scholar
  14. Durning, S. J., Pangaro, L. N., Lawrence, L. L., Waechter, D., McManigle, J., & Jackson, J. L. (2005). The feasibility, reliability, and validity of a program director’s (supervisor’s) evaluation form for medical school graduates. Academic Medicine,80(10), 5.CrossRefGoogle Scholar
  15. Erikson, E. (1964). Insight and responsibility. New York: Norton.Google Scholar
  16. Evans, N. J., Forney, D. S., & Guido-DiBrito, F. (1998). Student development in college: Theory, research and practice. San Francisco, CA: Jossey-Bass.Google Scholar
  17. Favreau, M. A., Tewksbury, L., Lupi, C., Cutrer, W. B., Jokela, J. A., & Yarris, L. M. (2017). Constructing a shared mental model for faculty development for the Core Entrustable Professional Activities for Entering Residency. Academic Medicine,92(6), 759–764.CrossRefGoogle Scholar
  18. Flexner, A. (1910). Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4., New York, NY: The Carnegie Foundation.Google Scholar
  19. Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report,20(9), 9.Google Scholar
  20. Hauer, K. E., ten Cate, O., Boscardin, C., Irby, D. M., Iobst, W., & O’Sullivan, P. S. (2014). Understanding trust as an essential element of trainee supervision and learning in the workplace. Advances in Health Sciences Education Theory and Practice,19(3), 435–456.Google Scholar
  21. Irby, D. (2011). Educating physicians for the future: Carnegie’s calls for reform. Medical Teacher,33(7), 547–550.CrossRefGoogle Scholar
  22. Jayakumar, K. L. (2016). Numerical USMLE Step 1 scores are still important in the selection of residency applicants. Academic Medicine,91(11), 1470–1471.CrossRefGoogle Scholar
  23. Kamel-El Sayed, S., & Loftus, S. (2018). Using and combining learning theories in medical education. Medical Science Educator,28(1), 255–258.CrossRefGoogle Scholar
  24. Lave, J., & Wenger, E. (1991a). Situated learning in communities of practice. In L. Resnick, J. Levine, & S. Teasley (Eds.), Perspectives on socially shared cognition (pp. 63–82). Washington, DC: American Psychological Association (APA).CrossRefGoogle Scholar
  25. Lave, J., & Wenger, E. (1991b). Situated learning: legitimate peripheral participation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  26. Lypson, M., & Simpson, D. (2011). It all starts and ends with the program director. Journal of Graduate Medical Education,3(2), 261–263.CrossRefGoogle Scholar
  27. Maxwell, J. A. (2010). Using numbers in qualitative research. Qualitative Inquiry,16(6), 475–482.CrossRefGoogle Scholar
  28. McDevitt, T. M., & Omrod, J. E. (2004). Child development: Educating and working with children and adolescents (2nd ed.). Upper Saddle River, NJ: Pearson.Google Scholar
  29. Mehta, N. B., Hull, A., & Young, J. (2016). More on how USMLE Step 1 scores are challenging academic medicine. Academic Medicine,91, 609.CrossRefGoogle Scholar
  30. National Residency Matching Program. (2014). Data Release and Research Committee: Results of the 2014 NRMP Program Director Survey. Washington, DC: National Resident Matching Program.Google Scholar
  31. Pock, A. R., Pangaro, L. N., Green, C. B., & Laughlin, L. (2013). Undergraduate medical education: Past, present, and future. Military Medicine,178(5), 474–478.CrossRefGoogle Scholar
  32. Quintero, G. A., Vergel, J., Arredondo, M., Ariza, M. C., Gomez, P., & Pinzon-Barrios, A. M. (2016). Integrated medical curriculum: Advantages and disadvantages. Journal of Medical Education and Curriculum Development,3, 133–137.Google Scholar
  33. Rajan, S. J., Jacob, T. M., & Sathyendra, S. (2016). Vertical integration of basic science in final year of medical education. International Journal of Applied Medical Research,6(3), 182–185.Google Scholar
  34. Rosenthal, S., Howard, B., Schlussel, Y. R., Lazarus, C. J., Wong, J. G., Moutier, C., et al. (2009). Does student membership in the Gold Humanism Honor Society influence selection for residency? Journal of Surgical Education,66(6), 308–313.CrossRefGoogle Scholar
  35. Schumacher, D. J., Poynter, S., Burman, N., Elliott, S. P., Barnes, M., Gellin, C., et al. (in press). Justifications for discrepancies between competency committee and program director recommended resident supervisory roles. Academic Pediatrics.Google Scholar
  36. Schuwirth, L. W., & Van der Vleuten, C. P. (2011). Programmatic assessment: From assessment of learning to assessment for learning. Medical Teacher,33, 478–485.CrossRefGoogle Scholar
  37. Sheu, L., O’Sullivan, P. S., Aagaard, E. M., Tad-y, D., Harrell, H. E., Kogan, J. R., et al. (2016). How residents develop trust in interns: A multi-institutional mixed-methods study. Academic Medicine,91(10), 1406–1415.CrossRefGoogle Scholar
  38. Sterkenberg, A., Barach, P., Kalkman, C., Gielen, M., & ten Cate, O. (2010). When do supervising physicians decide to entrust residents with unsupervised tasks? Academic Medicine,85(9), 1408–1417.CrossRefGoogle Scholar
  39. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Grounded theory procedures and techniques (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
  40. ten Cate, O. (2005). Entrustability of professional activities and competency-based training. Medical Education,39(12), 1176–1177.CrossRefGoogle Scholar
  41. ten Cate, O. (2013). Nuts and bolts of entrustable professional activities. Journal of Graduate Medical Education,5(1), 157–158.CrossRefGoogle Scholar
  42. ten Cate, O. (2016). Entrustment as assessment: Recognizing the ability, the right, and the duty to act. Journal of Graduate Medical Education,8(2), 261–262.CrossRefGoogle Scholar
  43. ten Cate, O., & Billett, S. (2014). Competency-based medical education: Origins, perspectives and potentialities. Medical Education,48(3), 325–332.CrossRefGoogle Scholar
  44. ten Cate, O., Hart, D., Ankel, F., Busari, J., Englander, R., Glasgow, N., et al. (2016). Entrustment decision making in clinical training. Academic Medicine,91(2), 191–198.CrossRefGoogle Scholar
  45. ten Cate, O., & Scheele, F. (2007). Viewpoint: Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice? Academic Medicine,82(6), 542–547.CrossRefGoogle Scholar
  46. ten Cate, O., Snell, L., & Carraccio, C. (2010). Medical competence: The interplay between individual ability and the health care environment. Medical Teacher,32(8), 669–675.CrossRefGoogle Scholar
  47. Torre, D. M., Daley, B. J., Sebastian, J. L., & Elnicki, D. M. (2006). Overview of current learning theories for medical education. The American Journal of Medicine,119(10), 903–907.CrossRefGoogle Scholar
  48. Ulmer, C., Wolman, D., & Johns, M. (Eds.). (2008). Resident duty hours: Enhancing sleep, supervision, and safety. Washington, DC: National Academies Press.Google Scholar
  49. United States Medical Licensing Examination. (2019). Invitational Conference on USMLE Scoring (InCUS). Retrieved July 28, 2019, from https://www.usmle.org/inCus/.
  50. Vygotsky, L. (1978). Mind in society. Cambridge, MA: Harvard University Press.Google Scholar
  51. Wenger, E. C., & Snyder, W. M. (2000). Communities of practice: The organizational frontier. Harvard Business Review,R00110, 139–145.Google Scholar

Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply  2020

Authors and Affiliations

  1. 1.Uniformed Services University of the Health SciencesBethesdaUSA

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