title: How clinical supervisors develop trust in their trainees: a qualitative study.
abstract: BACKGROUND
  Clinical supervisors oversee trainees' performance while granting them increasing opportunities to work independently. Although the factors contributing to supervisors' trust in their trainees to conduct clinical work have been identified, how the development of trust is shaped by these factors remains less clear.
  
  
  OBJECTIVE
  This study was designed to determine how supervisors develop and experience trust in resident (postgraduate years 2 and 3) trainees in the clinical workplace.
  
  
  METHODS
  Internal medicine in-patient supervisors at two institutions were interviewed about the meaning and experience of developing trust in resident trainees. Transcribed data were coded and analysed using a phenomenographic approach.
  
  
  RESULTS
  Forty-three supervisors participated. Supervisors characterised the meaning of trust from the perspectives of trainee competence and leadership or from their own perspective of needing to provide more or less supervision. Supervisors initially considered trust to be usually independent of prior knowledge of the resident, and then used sources of information about trust to develop their judgements of trust. Sources, which incorporated inference, included supervisors' comparisons with a standard, direct observation of the trainee as a team leader or care provider, and stakeholder input from team members, patients and families. Barriers against and accelerators to trust formation related to the resident, supervisor, resident-supervisor relationship, context and task. Trust formation had implications for supervisors' roles, residents' increasingly independent provision of care, and team functioning.
  
  
  CONCLUSIONS
  From a general starting point, supervisors develop trust in residents informed by observation, inference and information gathered from the team and patients. Judgements of trust yield outcomes defined by supervisors' changing roles, the increasingly independent provision of care by residents, and team functioning. The implications of these findings for graded resident autonomy aligned with learning needs can inform the design of training environments to enable readiness for unsupervised practice.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Oza
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Corrie A
authors.initials: CA
authors.lastname: Stankiewicz
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Terese
authors.initials: T
authors.lastname: Stenfors-Hayes
authors.affiliation: Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Olle Ten
authors.initials: OT
authors.lastname: Cate
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Batt
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California, USA.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: O'Sullivan
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D005260:Female; D020445:Hospitalists; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D035502:Trust / Q000523:psychology*; D014481:United States