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Record identifier : 569257
Personal Name - Primary Intelectual Responsibility : Kennedy, Tara Jane Tingley
Title and statement of responsibility : A fine balance: Patient safety and trainee education on clinical teaching teams [Thesis]
Publication, Distribution,Etc. : University of Toronto (Canada), 2008
Language of the Item : eng
Dissertation of thesis details and type of degree : Ph.D
Body granting the degree : , University of Toronto (Canada)
Summary or Abstract : Context. Clinical supervisors of medical trainees must provide supervision to ensure patient safety, while allowing enough independence to promote education. Current focus on patient safety has led to changes in supervisory practices without exploring their educational impact, creating an urgent need for an understanding of how the safety-education balance is enacted in medical training.Objectives. To explore the patterns of supervision currently provided by clinical supervisors, and to develop conceptual models of the factors involved in clinical teachers' decisions about supervision, and of the factors influencing trainee-supervisor communication about supervision.Design. In Phase 1, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants subsequently completed brief interviews. In Phase 2, 36 in-depth interviews were conducted using video vignettes to probe tacit influences on supervision. Data collection and analysis employed grounded theory methodology.Results. Clinical supervision practices related to patient care were found to involve routine oversight (oversight activities planned in advance), backstage oversight (oversight of which trainees are not directly aware), and responsive oversight (oversight occurring in response to trainee- or patient-specific issues). Supervisors' assessments of trainee trustworthiness for independent clinical work were found to involve consideration of trainees' knowledge and skill, discernment of clinical limitations, honesty, and conscientiousness. Supervisors' reliance on language cues as a source of trustworthiness data was revealed. Trainees' decisions about seeking help from supervisors were found to involve not only clinical factors (clinical significance, scope of practice), but also supervisor factors (availability, approachability), and trainee factors (expertise, desire for independence, evaluation). Trainees perceived that requesting frequent/inappropriate clinical support threatens credibility. The pressure on trainees to act independently was explored in light of educational and organizational theory, resulting in a new practical approach to patient safety during clinical training.Conclusions. This study offers an important theoretical advancement from the traditional conceptualization of the inverse relationship between safety and education in clinical training. Exposure and examination of the complexities involved in the constant trainee-supervisor negotiations about clinical independence provides a framework for changes that could simultaneously advance the patient care and educational agendas of medical education..
Topical Name Used as Subject : Health education
Information of biblio record : TL
 
 
 
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