Trust Between Teachers and Learners

Journal of the American Medical Association (05/13/19) Sklar, David P.; McMahon, Graham T.

In a commentary, University of New Mexico professor David Sklar, MD, and Graham McMahon, MD, MMSc, Accreditation Council for Continuing Medical Education president and CEO, write that the issue of trust between physician educators and learners has evolved into a core concern of health profession educators. "The trust of teachers is won when learners attend, engage, respond, and appreciate the teachers and their volunteerism," they note. "It takes time and repeated exposure for trust to be optimally developed, which implies both available time and longitudinal engagement that is increasingly absent." Sklar and McMahon add that such trust can erode if learners are not attentive, or skew toward ambivalence, distraction, opposition, dismissiveness, defensiveness, or lack of responsiveness. "Teachers must progressively relinquish control and supervision to their learners, attending to the safety of their shared patients," the authors recommend. "Based on the level of trust, students should progress from observing patient care, to performing it under continuous and direct supervision, to performing with indirect supervision with the teaching physician within close proximity to supervision from a distance; ultimately, the learner would be able to supervise others." A sense of trust in the institution and its learning environment also must be cultivated in teachers and learners. "By considering how systems, processes, and culture create and maintain trust, we can optimize both learning and care quality," Sklar and McMahon conclude.

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