AEM Education & Training 26: The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians

Welcome to the 26th episode of AEM Education and Training, a podcast collaboration between the Academic Emergency Medicine E&T Journal and Brown Emergency Medicine. Each quarter, we'll give you digital open access to AEM E&T Articles or Articles in Press, with an author interview podcast and links to curated supportive educational materials for EM learners and medical educators.

Find this podcast series on iTunes here.

DISCUSSIon(click title to access):

The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians. Shelly‐Anne Li PhD(c), MSc, Anita Acai PhD(c), MSc, Jonathan Sherbino MD, FRCPC, Teresa M. Chan MD, FRCPC, MHPE.

LISTEN NOW: Interview with Shelly-Anne Li, Anita Acai, and Teresa Chan MD

Shelly-Anne Li

Research and Quality Improvement Lead, University Health Network

Guideline Development Methodologist, Registered Nurses' Association of Ontario.

PhD Candidate, University of Toronto,

@ShellyAnneLi

Anita Acai

PhD Candidate, Psychology and Health Professions Education

Assistant Professor and Education Scientist, Department of Psychiatry and Behavioural Neurosciences at McMaster University

@anita_acai

Teresa M. Chan, MD

Associate Professor of EM, McMaster University

Assistant Dean, Program for Faculty Development in the Faculty of Health Sciences, McMaster University

ABSTRACT

Objectives

Emergency medicine is a fast‐paced specialty that demands emergency physicians to respond to rapidly evolving patient presentations, while engaging in clinical supervision. Most research on supervisory roles has focused on the behaviors of attending physicians, including their individual preferences of supervision and level of entrustment of clinical tasks to trainees. However, less research has investigated how the clinical context (patient case complexity, workflow) influences clinical supervision. In this study, we examined how the context of the emergency department (ED) shapes the ways in which emergency physicians reconcile their competing roles in patient care and clinical supervision to optimize learning and ensure patient safety.

Methods

Emergency physicians who regularly participated in clinical supervision in several academic teaching hospitals were individually interviewed using a semi‐structured format. The interviews were transcribed and analyzed using a constructivist grounded theory approach.

Results

Sixteen emergency physicians were asked to reflect on their clinical supervisory roles in the ED. We conceptualized a model that describes three prominent roles: teacher, assessor, and patient protector. Contextual features such as trainee competence, pace of the ED, patient complexity, and the culture of academic medicine influenced the extent to which certain roles were considered salient at any given time.

Conclusions

This conceptual model can inform researchers and medical educators about the role of context in accentuating or minimizing various roles of emergency physicians. Identifying how context interfaces with these roles may help design faculty development initiatives aimed to navigate the tension between urgent patient care and medical education for emergency physicians.