A fine balance: Patient safety and trainee education on clinical teaching teams
Bibliographic record
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. 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. 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. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.009 | 0.008 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".