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“Performance only improves when the feedback is absorbed and acted on,
and feedback requires the learner to trust the expertise and integrity of the person delivering that feedback. In medicine, this process relies heavily on personal relationships because the sophistication of the skills being taught and evaluated is not always reliably assessable.”
I’m straying a bit for today’s Piece of My Mind. This is from today’s JAMA Viewpoint and is titled Trust Between Teachers and Learners. The authors address the fact that medical education requires relationship. And an effective teaching relationship requires trust. Trust by the learner in the teacher. Trust by the teacher in the learner. Distrust causes fear and not feeling safe, which undermine learning and patient care.
This might seem a bit different from how you were trained. Perhaps in your medical education, learning from attendings and seniors was based more in fear rather than trust. Fear of being humiliated, disregarded, disrespected, or dismissed whether in the classroom or at the patient bedside. As you consider this you might be tempted to think that trust has nothing to do with teaching or that it is just a ‘millennial thing.” If so, please step back for a moment and look at the authors of this article. One of them is a physician at ACGME. Trust is critical to effective medical education and effective patient care. ACGME gets that and emphasizes/requires it in the clinical learning environment. You can count on Joint Commission to get it and, if not already, emphasize/require it in the clinical practice environment.
For Faculty: check your evaluation summaries by residents for the past year. How do residents view you on the core questions that relate to trust? Do you have opportunities for improvement?
Here are the relevant items:
L3. My attending made it safe for me to bring up concerns without fear of reprisal.
L4. My attending was approachable and accessible to address patient care questions.
L5. My attending showed respect to patients, other residents, colleagues and staff.
P1. My attending modeled behavior worthy of emulation.
P2. I would recommend to other residents that they work with this attending.
For Residents: How do those learners following you in training, such as interns and medical students, view you on this? Do they trust you? How would they evaluate you on the five items above?
Trust is a critical element of learning and practice. When we experience trust, it supports our growth as lifelong learners and practitioners. And that supports our wellbeing.
To Do: In less than 3 weeks, our new residents join us. And, with their anxiety in being new and doing more patient care than ever before, they will be watching carefully to see if we are safe and trustworthy to learn with. Here is a 5-minute video example of how seniors and attendings can create safety for interns to do bedside presentations.
Mike
Michael J. Schulein, Ph.D.
Faculty Development Lead
Division of Education-Marshfield Clinic Health System
Adjunct Clinical Assistant Professor, UW School of Medicine & Public Health