Self-entrustment: how trainees’ self-regulated learning supports participation in the workplace

Abstract

Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees’ learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees’ development, and to explore supervisor’s role herein. We conducted a qualitative non-participant observational study in seven general practices. During two days we observed trainee’s patient encounters, daily debriefing sessions and educational meetings between trainee and supervisor and interviewed them separately afterwards. Data collection and analysis were iterative and inspired by a phenomenological approach. To organise data we used networks, time-ordered matrices and codebooks. Self-regulated learning supported trainees to increasingly perform independently. They engaged in self-regulated learning before, during and after encounters. Trainees’ activities depended on the type of medical problem presented and on patient, trainee and supervisor characteristics. Trainees used their sense of confidence to decide if they could manage the encounter alone or if they should consult their supervisor. They deliberately used feedback on their performance and engaged in reflection. Supervisors appeared vital in trainees’ learning by reassuring trainees, discussing experience, knowledge and professional issues, identifying possible unawareness of incompetence, assessing performance and securing patient safety. Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees’ increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees’ self-regulated learning.

A systematic review of supervisory relationships in general practitioner training

“…On the whole, supervisors appeared to trust their trainees; they had sufficient confidence that the trainee would report problems and ask for help when required, and they supported the trainee's autonomy in their consultations with patients . However, caution was advised when relying heavily on trainee self‐assessment .…”

“…Trainees must be able to count on their supervisor for the support they require . However, the extent to which trainees experienced this support, or trusted it to happen, is less clear within the scope of this review.…”

“…The supervisory relationship must navigate numerous and potentially conflicting priorities. Trainee autonomy is required for learning, but must be balanced with patient safety . With educational development as the goal, supervisors aimed to support the trainee's learning needs, but monitoring and assessment during supervision risked trainee openness about their vulnerabilities …”

“…Supervisors ensured trainees were safe to practice autonomously, through having general oversight, monitoring progress and acting as a gatekeeper . Other roles included role model, assessor and mentor, through providing reassurance and personal support . Supervisors also facilitated inclusion of trainees by acting as a broker with the wider practice …”

Context matters when striving to promote active and lifelong learning in medical education

“…Additionally, learners may feel that patient care and learning are competing priorities . However, there might be a shift taking place in recent years, as more recent studies indicate that postgraduate trainees engage in self‐regulated learning before, during and after patient encounters, and deliberately use feedback on their performance and engage in reflection to guide their learning . This might indicate that the efforts to make undergraduate medical education more active, self‐regulated and learner centred are also having an effect on postgraduate learning.…”