Trust and risk pitfalls in medical education: A qualitative study of clinical teachers

Abstract

Purpose

Learning opportunities in teaching hospitals are gated by clinical teachers. One way to unpack their decision-making is to employ a ‘trust and risk’ model. This study aimed to uncover clinical teachers’ experience of trust, risk and vulnerability as they participate in medical education.

Methods

Hospital-based clinical teachers were interviewed about trust, risk and vulnerability in medical education. Data analysis was undertaken using a constructivist, qualitative framework.

Results

Twenty demographically diverse clinical teachers participated. Trust and risk were regarded as fundamental workplace and teaching concepts. Their concerns fell into three domains of risk: clinical, teaching and personal. Being trusted unlocked clinical learning opportunities, whereas trust failure limited future participation. Feeling trusted or not affected wellbeing and self-efficacy. Trust and risk pitfalls in education included bias, asymmetry and sidelining.

Conclusions

This study adds to the literature by voicing clinical teachers’ personal risks and vulnerabilities. Attention was drawn to the benefits of being perceived as trustworthy, and to the clinical, teaching and personal vulnerabilities of trust failure.

If expert judgement of trustworthiness is to be legitimised as meaningful assessment, clinical teachers must be aware not only of how trust is built, but also the pitfalls of trust failure.

Keywords:

• Trust
• risk
• clinical
• teaching
• workplace
• entrustable

Disclosure statement

The authors have no conflicting or monetary interests to declare.

Additional information

Funding

This research was kindly supported by an Australian Government Research Training Program Scholarship.

Notes on contributors

Arvin K. Damodaran

Arvin Damodaran, MBBS, MMedEd, is a Rheumatologist and Director of the Clinical Teaching Unit at Prince of Wales Clinical School, UNSW Sydney, Australia.

Philip Jones

Philip Jones, MBBS, PhD, is an Infectious Diseases Physician and prior Associate Dean (Education) for UNSW Medicine. He is now an Emeritus Professor, UNSW Sydney.

Boaz Shulruf

Boaz Shulruf, MPH, PhD, is Professor in Medical Education, at the Office of Medical Education, UNSW Sydney.