What teaching methods should we use as clinical supervisors according to residents training level?

What is it about?

A major challenge for clinical supervisors is to encourage residents´ independence without jeopardising patient safety. Previous research has not completely explored residents´ preferences in this regard. How do they want the clinical teacher to supervise them throughout the residency? What are the reasons behind these choices? In my first Ph.D. article, we investigate these preferences according to the resident level of training, including how and why the preferences differed between those levels.

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Why is it important?

The results of our study indicate that CS should accommodate to residents' varying degrees of development by attuning the arrangement of different 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. But how do we get to such conclusion? We present the residents a group of teaching methods based in the Cognitive Apprenticeship (CA) model as described by Collins et al. We asked each resident to rate the importance to their learning of each teaching method and to indicate which of these they preferred the most and why. All residents concurred that all CA teaching methods were crucial to their learning, regardless of their level of training. However, the reasons for their preferences differed between groups: junior and intermediate residents preferred more supervisor-directed teaching methods, such as modelling and coaching, whereas senior residents preferred more resident-directed teaching methods, such as articulation. Through modelling, clinical supervisors show trainees how to perform a given task, emphasising the elements that elicit a correct performance. In the next process, coaching, supervisors observe trainees performing the task and provide feedback to improve their overall performance. By doing articulation, clinical teachers induce trainees to provide the reasoning behind their decisions. While doing so, clinical teachers also promote reflection, a process that helps students understand their strengths and weaknesses. But what reasons exists behind these preferences? Junior residents considered modelling and coaching crucial methods for a rapid construction of solid clinical skills, for encouraging junior residents' reflection about their strengths and weaknesses and for minimising errors that would arise from unsupervised practice. Intermediate residents, perceived articulation as a method that helped them develop decision-making skills and expand their knowledge base. However, what figured as most important at this stage of training was a combination of coaching and independent practice. Senior residents set great store by articulation, which allowed them to expand their knowledge base and engage themselves in dialogue with the supervisor. As a result, they could participate more actively in the patient-care process while still being under non-authoritative supervision.

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