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Trusted to perform: Clerkship students’ perspectives on the role of trust in the clinical learning environment


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Trusted to perform: Clerkship students’ perspectives on the role of trust in the clinical learning environment



Role of Trust in Medical Education

•  Aligning learning objectives with patient care goals requires trust between supervisors and trainees; appropriate trust enables trainees to gain competence through increasing levels of responsibility[1]

• Core clerkships mark the beginning of this process for medical students as they transition into more central patient care roles

Factors Influencing Trust

• Previous studies on how attendings trust residents, and how residents trust interns, have yielded five factors important to trust[2][3]


Study Objective

• To understand clerkship students’ perceptions of factors yielding appropriate, over-, and under-trust and the impact these levels of trust have on their learning experiences



Study Design and Participants

•Qualitative, exploratory study of core clerkship students at UCSF; 16 of 30 randomly selected students individually interviewed

Interview Guide

•Open-ended questions eliciting examples of students experiencing over-, under-, and appropriate levels of trust by supervising interns, residents, and attendings

Thematic Analysis

•Transcripts analyzed for themes related to students’ perceptions of trust afforded to them by supervisors
Conclusions & Future Directions

Student Perceptions of Trust

•Perceptions of trust strongly impact learners/learning, as well as relationships with supervisors/teams
•Continuity and coaching/supervision foster a sense of appropriate trust, as well as student comfort in the clinical learning environment

Optimizing Trust

•Optimizing trust through appropriate supervision may increase students' professional satisfaction, motivation to seek appropriate level of responsibility, and sense of competence
•Concerns about academic performance and evaluations impede students' ability to address perceived over- and under-trust

Next Steps

•Train supervisors to balance incremental trust with supervision when working with students; train students to identify and address issues related to trust
•Reframe evaluations and grades in a way that empowers students to address issues related to supervision and autonomy



[1] Hauer KE, Ten Cate O, Boscardin C, et al. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ Theory Pract. 2014;19(3):435–456.

[2] Hauer KE, Oza SK, Kogan JR, et al. How clinical supervisors develop trust in their trainees: A qualitative study. Med Educ. 2015;49:783–795.

[3] Sheu L, O’Sullivan PS, Aagaard EM, et al. How residents develop trust in interns: A multi-institutional mixed-methods study. Acad Med. 2016;91:1406–1415

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