Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support.
OBJECTIVE
To develop a conceptual framework of the influences on medical trainees' decisions regarding requests for clinical support from a supervisor.


METHODS
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.


METHODS
Three teaching hospitals in an urban setting in Canada.


METHODS
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.
Kennedy
Tara J T
TJ
Wilson Centre for Research in Education, Toronto, ON, Canada. tara.kennedy@utoronto.ca
Regehr
Glenn
G
Baker
G Ross
GR
Lingard
Lorelei
L
D002983:Clinical Competence / Q000592:standards; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D009864:Ontario; D011361:Professional Competence / Q000592:standards*; D013337:Students, Medical / Q000523:psychology; D013663:Teaching