"Who wants me to do what?" varied expectations from key stakeholder groups in the surgical intensive care unit creates a challenging learning environment

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

BACKGROUND

Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement.

METHODS

We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes.

RESULTS

Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees' ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees' progress visualisation, which is caused by unsatisfactory familiarisation with the trainees' development. The lack of an overview of a trainee's previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym "ICU-STAR" representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment.

CONCLUSIONS

According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee's development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees' assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym "ICU-STAR" as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points.

TRIAL REGISTRATION

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How have women health care adjusted their approach to work-life balance as the world adapts to the "new normal ?

During a pandemic, the responsibility of care is rightly shifted from the individual patient to safeguard the health of the large community. The coronavirus pandemic has reshaped the healthcare landscape, placing a strain on all healthcare workers, especially women in healthcare. During the ongoing COVID-19 Pandemic, the threatening pressure on the healthcare system has forced governments and healthcare systems to formulate complex policies to decide how to allocate limited resources. Women also make up one-third of the majority of frontline healthcare professionals around the world, making them vital to tackle this public health crisis. Many women also combine work-home life, personal relationships, caring for family members, home teaching, parenting, their emotional and physical health, and more during new normal. Women are at the forefront of the response to the Pandemic, as they make up nearly 80% of healthcare workers and more than one-third of the active doctors, putting them at greater risk of infection. At the same time, they are underrepresented in decision-making and leadership in the healthcare sector.