Preserving professional credibility: grounded theory study of medical trainees’ requests for clinical support
BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b128 (Published 09 February 2009) Cite this as: BMJ 2009;338:b128
- Tara J T Kennedy, research fellow1, developmental paediatrician23,
- Glenn Regehr, Richard and Elizabeth Currie chair in health professions education research and professor4, scientist5, associate director1,
- G Ross Baker, professor of health policy, management and evaluation4,
- Lorelei Lingard, scientist16, associate professor7, BMO financial group professor and education scientist8
- 1Wilson Centre for Research in Education, Toronto, ON, Canada
- 2Bloorview Kids Rehab, Toronto, ON, Canada
- 3Stan Cassidy Centre for Rehabilitation, Fredericton, NB, Canada
- 4Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- 5Toronto General Research Institute, University Health Network, Toronto, ON, Canada
- 6SickKids Learning Institute, Toronto, ON, Canada
- 7Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- 8University Health Network, Toronto, ON, Canada
- Correspondence to: T Kennedy tara.kennedy{at}utoronto.ca
- Accepted 7 October 2008
Abstract
Objective To develop a conceptual framework of the influences on medical trainees’ decisions regarding requests for clinical support from a supervisor.
Design Phase 1: members of teaching teams in internal and emergency medicine were observed during regular clinical activities (216 hours) and subsequently completed brief interviews. Phase 2: 36 in depth interviews were conducted using videotaped vignettes to probe tacit influences on decisions to request support. Data collection and analysis used grounded theory methods.
Setting Three teaching hospitals in an urban setting in Canada.
Participants 124 members of teaching teams on general internal medicine wards and in the emergency department, comprising 31 attending physicians, 57 junior and senior residents, 28 medical students, and eight nurses. Purposeful sampling to saturation was conducted.
Results Trainees’ decisions about whether or not to seek clinical support were influenced by three issues: the clinical question (clinical importance, scope of practice), supervisor factors (availability, approachability), and trainee factors (skill, desire for independence, evaluation). Trainees perceived that requesting frequent/inappropriate support threatened their credibility and used rhetorical strategies to preserve credibility. These strategies included building a case for the importance of requests, saving requests for opportune moments, making a plan before requesting support, and targeting requests to specific team members.
Conclusions Trainees consider not only clinical implications but also professional credibility when requesting support from clinical supervisors. Exposing the complexity of this process provides the opportunity to make changes to training programmes to promote timely supervision and provides a framework for further exploration of the impact of clinical training on quality of care of patients.
Footnotes
We thank Douglas Buller of the Wilson Centre, University of Toronto, for his technical expertise in the production of the videos, and Lisa Kitchen of the University of Ontario Institute of Technology for her invaluable work in data collection and study coordination.
Contributors: All authors contributed to the conception and design of the study, the analysis and interpretation of the data, critical revision of the manuscript, and obtaining funding for the study. They are all guarantors. TJTK acquired the data and drafted the manuscript.
Funding: This study was supported by an operating grant from the Canadian Institutes of Health Research (CIHR), which had no involvement in the research process. LL is supported by a CIHR New Investigators Award.
Competing interests: None declared.
Ethical approval: This study was approved by the institutional review board, and informed consent was given by all participants.
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