eprintid: 35477 rev_number: 11 eprint_status: archive userid: 8475 dir: disk0/00/03/54/77 datestamp: 2024-11-21 08:24:26 lastmod: 2024-11-21 12:54:22 status_changed: 2024-11-21 08:24:26 type: doctoralThesis metadata_visibility: show creators_name: Lerch, Seraina Petra title: How can trust be built, enabled, and used as a teaching paradigm in the context of medical education? divisions: i-100200 adv_faculty: af-10 abstract: In the context of medical education, trust, as a basic human phenomenon, is highly relevant because healthcare trainees need to learn how to establish trusting relationships with their future patients, and how to effectively contribute to patient care; therefore, trusting relationships also need to be established with their supervisors and educators. Furthermore, the newest paradigms in medical education use the concept of trust to increase the quality of teaching, reduce the complexity of teaching in the clinical field instead of the classroom, and to display the supervisor-trainee relationships. The aims of this thesis are therefore to describe in what ways trust can be used as a teaching paradigm in medical education (Aim I), to summarize how trainee-supervisor trust and patient-physician trust can be built (Aim II), and to present what needs to be taught and how to enable future healthcare professionals to build trusting relationships with their patients (Aim III). Finally, Aim IV involves the integration of the obtained information from all the aims into one model. To explore how trust can be built, enabled, and used as a teaching paradigm in the context of medical education, several studies were conducted: Papers I (Lerch, Pinilla, et al., 2023) and II (Pinilla et al., 2023) contain an exploration of how trust can be used as a teaching paradigm (Aim I). Teaching includes the learning objectives, methods, and assessments. In paper I (Lerch, Pinilla, et al., 2023), learning objectives and the concept of entrustment were explored. For paper II (Pinilla et al., 2023), common rating scales and entrustment scales – meaning asking assessors how much they would trust a particular examinee with clinical work in their hospitals – were compared. The entrustment scales reduced complexity and were preferred by assessors despite the perceived subjectivity of the assessment. This subjectivity was not confirmed, however, by the considered psychometric properties. How trust can be built was investigated for both trainee supervisor (Paper III by Lerch, Huwendiek, et al. (2023)), and patient-physician trust (Paper IV by Lerch, Hänggi, et al. (2023)). For trainee-supervisor trust, two frameworks on how it can be built already exist, revealing the thus far under-researched importance of context as a contributor to trust. These contextual factors were further explored in semi-structured interviews (Paper III by Lerch, Huwendiek, et al., 2023)), revealing the organizational structures and clinical service needs that contribute to supervising physicians trusting their trainees with clinical tasks. In paper IV (Lerch, Hänggi, et al., 2023) evidence-based precursors of patient-physician trust were integrated into a model through a critical review confirming as contributors, as indicated in basic trust research, the benevolence, integrity, and competence of the trustee. Moreover, other psychological factors, the social environment, and health education of the trustor were also revealed as relevant contributors to patient-physician trust, as well as the context and relationship. To investigate what needs to be taught and how to enable healthcare trainees to build trust with their future patients, an expert consensus study 4 (Paper V by Lerch, Bussmann, et al. (2023)) was conducted, and the systematically synthesized teaching ingredients and methods needed to enable trust were thereby obtained. Most importantly, longitudinal safe relationships with supervisors as role models, feedback, and supporting students to be change agents can be applied. In paper VI (Felber et al., 2023), a brief educational intervention for medical students to enhance compassion – a precursor of trust – is described. The basic principles of this intervention can be expected to inform future interventions for medical trainees that enable them to build trust with their future patients. In addition, the information on how trust can be built, enabled, and used as a teaching paradigm in medical education was integrated into a socioeconomic model, based on the finding that next to interpersonal factors, contextual factors need to be considered to build trust. The common findings of the first three aims are the importance of feedback, longitudinal relationships and sufficient supervision of trainees, and psychological safety to build and enable trust and to use it as a teaching paradigm in medical education. In summary, the fundamental role of trust in medical education has been explored. Trust matters in current teaching paradigms in medical education, in trainee-supervisor relationships facilitating learning, and in patient-physician relationships. Therefore, trainees need to learn to build trust with future patients. The key findings include the importance of context in interpersonal trust, feedback, long-term relationships, sufficient supervision, and psychological safety when talking about trust in the context of medical education. The results of this thesis contribute valuable insights into the role of trust in shaping the education and practice of future physicians, their current educators and policy makers. date: 2024 id_scheme: DOI id_number: 10.11588/heidok.00035477 ppn_swb: 1909316962 own_urn: urn:nbn:de:bsz:16-heidok-354771 date_accepted: 2024-09-09 advisor: HASH(0x5589ef6a0680) language: eng bibsort: LERCHSERAIHOWCANTRUS2024 full_text_status: public place_of_pub: Heidelberg citation: Lerch, Seraina Petra (2024) How can trust be built, enabled, and used as a teaching paradigm in the context of medical education? [Dissertation] document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/35477/1/Dissertation%20Seraina%20Lerch%20PDFA.pdf