Today I have Meg Wolfe here with me in the studio. Meg and I have been doing a workshop on entrustment for quite a while with a couple of other folks who you'll meet later in this course. Meg and I really have been thinking deeply about what entrustment looks like and how do we offer autonomy and how do we give residents responsibility. Today we're going to start by debriefing some of the videos and starting with the video that just, that we just watched. Meg, tell me a little bit about your work and then we'll go into the video. >> Alright, yeah, I, I'm attending in the pediatric emergency department. So I work with loners of all levels. It can be a challenging environment for entrustment because there are, there's face paced, high It can busy. And how you're dealing with the, the patients and their families. It is tough. >> Yeah. >> Yeah. >> So what did you think about Josh's performance there? It was so, so it was Josh who was a resident and supervising Emily, who was a, a junior resident. What did you think about his work? >> I can relate to it a little bit. >> Mm-hm. >> I can see how easy that would be for that to happen. >> Mm-hm. >> There's certainly some things though that Josh did that I can understand, probably made Emily feel uncomfortable. >> Yeah. >> You know he walked right in there and said I'm the boss. >> Yeah. >> And right from there it changed the total, the whole dynamic of the, of their interaction with the patient. >> Yeah the patient just completely looked over at him. >> Oh yeah. >> And stopped looking at Emily completely. >> Absolutely the whole time she just looked. Whenever, even when Emily would ask a question. She would respond to Josh. >> Yeah. >> You know, he also stood the whole time. and, and so the dynamic I mean, Emily was standing as well, but Josh was just standing there and made it easier for the patient just to look directly to him and, and not at, at Emily. >> Mm-hm. And then he ordered stuff, like you get, have you gotten an EKG yet, kind of like challenging her, undermining her, her credibility. >> Right, right, and I, I can imagine that probably looked to the patient like, oh she doesn't know what she's doing, he's coming here right off the bat, he already knows what to order. >> Hm. >> so, and that sort of ended the interaction. >> Mm-hm. Yeah, and so I think, let's see, if I were, if I were to try and do that better, I'd probably kind of slide in. >> Mm-hm. >> It would have bee, you know, if, if Josh, was either sitting down. >> Mm-hm. >> Or that he's standing behind Emily in such a way that Emily was still included in that, in that, that interaction. >> Mm-hm. >> And certainly he has to introduce himself. And, and, and they need to know that he's the supervising doctor but they way that he did it. As I'm the boss sort of made it seem like, well. I only had to say it. It wasn't important at all. >> Yeah and so I think I usually say, I'm the supervising physician. >> Mm-hm. >> I'm working with. >> Yes. >> And then I may actually put kind of like a little snippet of, of you know I really trust in Emily or I know she's gotten stuff started or some thing that shows that I trust what they are doing. >> Right, right, right. And sometimes saying you know I know you've already been talking. Emily, do you want to, do you want to brief on what what you've learned or something like that. Just to acknowledge that she's already been in here with the patient and, and probably already has an idea of what she wants to do. >> Yeah. Yeah. I think, I think those are really good points.