For medical students who are looking ahead to their first year of residency, understanding what forms the foundation of senior residents’ trust in junior colleagues can be an important part of that transition. A new study reveals factors that help build trust and maximize autonomy of interns under resident supervision.

While many factors go into the formation of trust, six in particular stood out from interviews with residents, as explained in new research findings in Academic Medicine. The authors of the study conducted interviews between January and March 2015 with 478 residents from five internal medicine programs. The interviews were rooted in a model for how residents develop trust in interns, which was created through preliminary interviews with residents at the University of California, San Francisco.

Residents rated three intern characteristics highest in terms of their importance for building trust: Reliability, competence and propensity to make errors. Three contextual factors also emerged as highly important: access to an electronic health record (EHR), duty hours and patient characteristics.

  • Reliability: Residents reported higher trust of interns who were able to prioritize tasks, follow through and seek help as needed.
  • Competence: Residents said that interns show their competence by devising and implementing plans of care, responding to new and acute issues, and demonstrating knowledge.
  • Propensity to make errors: Overlooking a lab value or ordering a wrong medication obviously can erode residents’ trust in an intern, but interviewees also indicated that interns build trust by responding to feedback and cutting down on errors.
  • Access to an EHR: An important aspect of an EHR is that it allows residents to remotely monitor interns as they complete critical tasks. This enables greater intern autonomy while allowing residents to fulfill supervisory duties.
  • Duty hours: Residents report that they get a clearer picture of interns’ competence and thoroughness when they handle more tasks themselves on the interns’ days off.
  • Patient characteristics: An environment in which there are many patients fosters greater trust, as residents are not able to provide the same level of supervision for every patient. Sicker patients are associated with less trust-building between interns and residents because these patients require more attention from all team members, which limits intern autonomy.

Residents also described how they had a harder time trusting interns when they themselves were new to the supervisory role, but over time they became more confident in building trust and relinquishing responsibilities to interns.

“Residents appear to consider trust in a way that prioritizes interns’ execution of essential patient care tasks safely within the complexities and constraints of the hospital environment,” the authors wrote.

The study’s findings could help medical students understand how to build professional relationships during residency and suggests that environmental, routine and curriculum changes could better foster the formation of trust, authors noted.

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