Understanding how residents’ preferences for supervisory methods change throughout residency training: a mixed-methods study

BMC Medical Education

Renée E. Stalmeijer¹  Jeroen Donkers¹  Diana Dolmans¹  Francisco Olmos-Vega² 

[1] Maastricht University, Maastricht, 6200 MD, The Netherlands;Anaesthesiology Department, San Ignacio Hospital, Carrera 7 N42-00 Fourth floor, Bogotá, DC, Colombia

关键词: Workplace learning;    Residency;    Cognitive Apprenticeship;    Postgraduate training;    Clinical Supervision;   

Others  :  1228662
DOI  :  10.1186/s12909-015-0462-7

 received in 2015-06-10, accepted in 2015-10-09,  发布年份 2015

【 摘 要 】

Background

A major challenge for clinical supervisors is to encourage their residents to be independent without jeopardising patient safety. Residents’ preferences according to level of training on this regard have not been completely explored. This study has sought to investigate which teaching methods of the Cognitive Apprenticeship (CA) model junior, intermediate and senior residents preferred and why, and how these preferences differed between groups.

Methods

We invited 301 residents of all residency programmes of Javeriana University, Bogotá, Colombia, to participate. Each resident was asked to complete a Maastricht Clinical Teaching Questionnaire (MCTQ), which, being based on the teaching methods of CA, asked residents to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why.

Results

A total of 215 residents (71 %) completed the questionnaire. All concurred that all CA teaching methods were important or very important to their learning, regardless of their level of training. However, the reasons for their preferences clearly differed between groups: junior and intermediate residents preferred teaching methods that were more supervisor-directed, such as modelling and coaching, whereas senior residents preferred teaching methods that were more resident-directed, such as exploration and articulation.

Conclusions

The results indicate that clinical supervision (CS) should accommodate to residents’ varying degrees of development by attuning the configuration of CA teaching methods to each level of residency training. This configuration should initially vest more power in the supervisor, and gradually let the resident take charge, without ever discontinuing CS.

【 授权许可】

   
2015 Olmos-Vega et al.

【 图 表 】

Fig. 1.

Figure 2.

【 参考文献 】

• [1]Kennedy TJ, Regehr G, Baker GR, Lingard LA. Progressive independence in clinical training: A tradition worth defending? Acad Med. 2005; 80:S106-S111.
• [2]Kennedy TJ, Lingard LA. Questioning competence: a discourse analysis of attending physicians’ use of questions to asses trainee competence. Acad Med. 2007; 82(10 Suppl):S12-15.
• [3]Kennedy TJ, Lingard LA, Baker GR. clinical oversight: conceptualizing the relationship between supersion and safety. J Gen Intern Med. 2007; 22(8):1080-1085.
• [4]Kennedy TJ, Regehr G, Baker GR, Lingard LA. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008; 83(10 Suppl):S89-92.
• [5]Ten Cate O, Scheele F. Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Acad Med. 2007; 82(6):542-547.
• [6]Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M et al.. A Systematic Review: The effect of clinical supervision on patient and residency education outcomes. Acad Med. 2012; 87:428-442.
• [7]van der Leeuw RM, Lombarts KM, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC Med. 2012; 10:65-77. BioMed Central Full Text
• [8]Kilminster SM, Cottrel D, Grant J, Jolly BC. AMEE Guide N° 27: Effective educational and clinical supervision. Med Teach. 2007; 29:2-19.
• [9]Collins A. Cognitive Apprenticeship. The Cambridge Handbook Of The Learning Sciences. Sawyer RK, editor. Cambridge University Press, Cambridge; 2006.
• [10]Stalmeijer R, Dolmans DHJM, Wolfhagen IHAP, Scherpbier AJJA. Cognitive apprenticeship in clinical practice: can it stimulate learning in the opinion of students? Adv Health Sci Educ. 2008; 14:535-546.
• [11]Stalmeijer R, Dolmans DHJM, Snellen-Balendong HAM, Van Santen-Hoeuff M, Wolfhagen IHAP, Scherpbier AJJA. Clinical Teaching Based on Principles of Cognitive apprenticeship: Views of Experienced Clinical Teachers. Acad Med. 2013; 88:861-865.
• [12]Ronnestad MH, Skovholt TM. Supervision of beginning and advanced graduate students of counseling and psycotherapy. J Coun Dev. 1993; 71:396-406.
• [13]Johnson RB, Onwuegbuzie AJ. Mixed Methods Research: A Research Paradigm Whose Time Has Come. Educ Res. 2004; 33:14-26.
• [14]Harats D, Leibovitz E, Maislos M, Wolfovitz E, Chajek-Shaul T, Leitersdorf E et al.. Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study. Isr Med Assoc J. 2005; 7(6):355-359.
• [15]Giannasi S, Durante E, Ladenheim R, Kecskes R, Vázquez F, Stalmeijer R et al.. Transcultural validation in Spanish of the Maastricht Clinical Teaching Questionnaire (MCTQ) as a Valid and Reliable Instrument for the Evaluation of Clinical Teachers. AMEE, Milano, Italy; 2014.
• [16]Stalmeijer R, Dolmans DHJM, Wolfhagen IHAP, Muijtjens AMM, Scherpbier AJJA. The Maastricht Clinical Teaching Questionnaire (MCTQ) as a Valid and Reliable Instrument for the Evaluatin of clinical Teachers. Acad Med. 2010; 85:1732-1738.
• [17]Stalmeijer R, Dolmans DHJM, Wolfhagen IHAP, Peters WG, Van Coppenolle L, Scherpbier A. Combined student ratings and self-assessment provide useful feedback for clinical teachers. Adv Health Sci Educ. 2010; 15:315-328.
• [18]Creswell JW. Qualitative Inquiry & Research Design. Choosing Among Five Approaches. 3rd ed. Sage Plubications, California; 2013.
• [19]Dexter F, Lognivov I, Brull S. Anesthesiology residents’ and nurse anesthetists’ perceptions of effective clinical faculty supervision by anesthesiologists. Anesth Analg. 2013; 116(6):1352-1355.
• [20]Boor K, Teunissen PW, Scherpbier AJJA. Residents’ perceptions of the ideal clinical teacher: A qualitative study. Eur J Obstet Gynecol Reprod Biol. 2008; 140(1):152-157.
• [21]Busari J, Weggelaar N, Knottnerus A. How medical residents percieve the quality of supervison provided by attending doctors in the clinical setting. Med Educ. 2005; 39(7):696-703.
• [22]Chur-Hansen A, McLean S. Trainee psychiatrits’ views about their supervisors and supervision. Australas Psychiatry. 2007; 15(4):269-272.
• [23]Teunissen PW, Scheele F, Scherpbier AJJA, Van Der Vleuten CPM, Boor K, Van Luijk SJ et al.. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007; 41(8):763-770.
• [24]Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE guide N° 63. Med Teach. 2012; 34:e102-e115.