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‘Whatever you cut, I can fix it’: clinical supervisors’ interview accounts of allowing trainee failure while guarding patient safety
  1. Jennifer M Klasen1,
  2. Erik Driessen2,
  3. Pim W Teunissen3,4,
  4. Lorelei A Lingard5,6
  1. 1Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
  2. 2Education Development and Research, Maastricht University, Maastricht, The Netherlands
  3. 3Workplace Learning in Healthcare, School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, The Netherlands
  4. 4Department of Obstetrics an Gynecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
  5. 5Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  6. 6Department of Medicine, University of Western Ontario, London, Ontario, Canada
  1. Correspondence to Dr Jennifer M Klasen, Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel 4031, Switzerland; Jennifer.Klasen{at}clarunis.ch

Abstract

Background Learning is in delicate balance with safety, as faculty supervisors try to foster trainee development while safeguarding patients. This balance is particularly challenging if trainees are allowed to experience the educational benefits of failure, acknowledged as a critical resource for developing competence and resilience. While other educational domains allow failure in service of learning, however, we do not know whether or not this strategy applies to clinical training.

Methods We conducted individual interviews of clinical supervisors, asking them whether they allowed failure for educational purposes in clinical training and eliciting their experiences of this phenomenon. Participants’ accounts were descriptively analysed for recurring themes.

Results Twelve women and seven men reported 48 specific examples of allowing trainee failure based on their judgement that educational value outweighed patient risk. Various kinds of failures were allowed: both during operations and technical procedures, in medication dosing, communication events, diagnostic procedures and patient management. Most participants perceived minimal consequences for patients, and many described their rescue strategies to prevent an allowed failure. Allowing failure under supervision was perceived to be important for supporting trainee development.

Conclusion Clinical supervisors allow trainees to fail for educational benefit. In doing so, they attempt to balance patient safety and trainee learning. The educational strategy of allowing failure may appear alarming in the zero-error tolerant culture of healthcare with its commitment to patient safety. However, supervisors perceived this strategy to be invaluable. Viewing failure as inevitable, they wanted trainees to experience it in protected situations and to develop effective technical and emotional responses. More empirical research is required to excavate this tacit supervisory practice and support its appropriate use in workplace learning to ensure both learning and safety.

  • continuing education, continuing professional development
  • medical education
  • patient safety
  • qualitative research
  • safety culture
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Footnotes

  • Contributors JMK and LAL developed the study, ED and PWT contributed to the study design. JMK collected the data, while both, JMK and LAL analysed the data. JMK, LAL, ED and PWT contributed to the interpretation of the data. JMK wrote the first draft of the paper, while both, LAL and JMK revised following drafts and all authors contributed to the process and the final revision.

  • Funding This study was supported by funds that LAL received from the Department of Medicine POEM program at the Schulich School of Medicine & Dentistry, Western University.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Yes (Switzerland and Canada)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

  • Author note The results and conclusions of this article are the authors’ own and do not represent the views of organizations providing support or otherwise involved.

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