Objective To develop a conceptual framework of the influences on
medical trainees’ decisions regarding requests for clinical support from a
Design Phase 1: members of teaching teams in internal and emergency
medicine were observed during regular clinical activities (216 hours) and
subsequently completed brief interviews. Phase 2: 36 in depth interviews were
conducted using videotaped vignettes to probe tacit influences on decisions to
request support. Data collection and analysis used grounded theory methods.
Setting Three teaching hospitals in an urban setting in Canada.
Participants 124 members of teaching teams on general internal
medicine wards and in the emergency department, comprising 31 attending
physicians, 57 junior and senior residents, 28 medical students, and eight
nurses. Purposeful sampling to saturation was conducted.
Results Trainees’ decisions about whether or not to seek clinical
support were influenced by three issues: the clinical question (clinical
importance, scope of practice), supervisor factors (availability,
approachability), and trainee factors (skill, desire for independence,
evaluation). Trainees perceived that requesting frequent/inappropriate support
threatened their credibility and used rhetorical strategies to preserve
credibility. These strategies included building a case for the importance of
requests, saving requests for opportune moments, making a plan before requesting
support, and targeting requests to specific team members.
Conclusions Trainees consider not only clinical implications but
also professional credibility when requesting support from clinical supervisors.
Exposing the complexity of this process provides the opportunity to make changes
to training programmes to promote timely supervision and provides a framework
for further exploration of the impact of clinical training on quality of care of