The next thing is the Level of Training.
So if I don't actually know the resident, or I know them just peripherally then I
may choose the level of training as a surrogate.
So I may say, you know this is a medical student, or
this is an intern, or a first year resident.
And so based on their level of training I may.
And give more or less autonomy based on what level they're in.
This may or may not be appropriate because interns are great and
some interns are not.
And when you really think about it, it's really based on the individual case.
It's just because someone is a fourth year resident,
does not mean that they've seen a case of fiber toxicosis.
Right? They may not have any idea how to
manage that.
And so it can be a little bit of a fallacy along the way, but it is one of
the ways that we determine how much in trust that we're going to give them.
The other one is experience, and so if one of the residents has not been at my
site for a long time, I've been practicing at the University of Michigan, but
let's say the, the residents had been at St. Joe's or one of the other hospitals.
Then I may get them more of less experience.
More or less autonomy, based on their experience and to also.
Kind of with level of training.
If they're brand new then I may give them less,
if they have quite a bit of experience I may give them more.
You know, some of our residents have actually done a couple years of
orthopedics first, so clearly I'm going to give them more autonomy than others
simply based on their previous training.
Another thing is their Communication Skills.
This is something that really does affect,
how much investment that we give a trainee?
If they can't really communicate well with us,
then we're going to assume that they don't really know whats going on and
we're probably not going to trust them very much.
For example if a resident or a student gives a completely jumbled up history and
physical and then comes up with a plan that might be organized,
I'm really going to think that they don't really know what's going on.
And I'm probably going to trust them less.
So I would probably go and
take a history more rapidly than I would if they really gave me a clear history.
I'm going to go back and
double check a number of issues on their case, so that I can get a better picture.
So really based on what the patient presentation is,
we get a sense of what they know and don't know.
Which may or may not be correct, because the,
the resident could have been completely incorrect about what they found, but
if they can present it in an organized pattern then I'm going to trust what they
have to say, so be careful about that.
and, which is why we always go back and trust and verify what we're going through,
what we're going through.
Another thing is the Direct Observation.
So if, if I'm in a room and the resident seems to be doing a really nice job and
taking an organized history and
just seems clear about their the, the problem that they're coming up with.
And they're, you know, good in the information that they're taking,
they've taken good communi,
communication skills, then I may actually step out of the room rather rapidly.
Even if it is a critical patient,
because through that direct observation I decided that I could trust them.
And then it also is related to what we talked about previously as
patient presentation.
So I think as faculty members we look very carefully about the true competence and
ability of the trainee, by the way that they present themselves or
present their patients and when we watch them.
Through direct observation and
each of those relate to how much interest that we give them.
The other one is kind of estimated experiences,
that kind of comes back to level.
If they've done a month of anesthesia, then I'm probably going to be
more willing to let the more innovative patient, whereas if they haven't done any
anesthesia, I may not be able, willing to let them do an insubation so clearly.
And another thing is whether or not they ask for help.
I think residents often feel like asking for help is maybe a sign of weakness, but
for me as a faculty member when a resident asks for
help, it really says to me that they understand their limitations.
And so.
It lets me know that I can trust them to you know,
to really kind of let out the leash, to give them more reign, so that they'll,
because I know that they'll come to me and ask a question when they have a question.
And so whether or not they're asking for help,
we'll probably give them, I'll give them more autonomy rather than less autonomy.
