Table 3. Quotes from the interviews illustrating the main themes
Supervisors’ leadership style Theme 1: Supervisors’ leadership style influences the atmosphere for training Theme 2: Supervisors’ leadership style influences the availability of job resources Theme 3: Supervisors’ leadership style serves as role model for how to handle the environment
Transformational These supervisors, undoubtedly, create a better work environment. The hardest part of residency is not the workload, fasting, or the lack of sleep, but having a good relationship with the supervisors and peers. A quiet environment makes it easier for residents to work hard. (Interview #12: 4th-year male resident) This type of leader offers the resident opportunities to be autonomous -within the framework of patient safety- to identify what [the resident] is doing well, and to have confidence ... They [the supervisors] tell him/her: "I want to operate on this patient with you,” or “you are going to operate on this patient." These are ways to strengthen autonomy, which causes the resident to fight his/her own demons [fears]. (Interview #3: 3rd-year male resident) All of us [residents] have difficult times during residency. If you have a role model, a supervisor with whom to share the anguish, that's good, that can help you to stay in the program. You admire some supervisors, not only because of their surgical capabilities, but also because of their integrity, because they are good human beings ... Sometimes you have big problems, but they can help you to see them smaller. These models make you see the problems from other angles to solve them. (Interview #1: 2nd-year female resident)
Transactional When leadership is based on punishment, the academic and work environments are hostile. Residents’ behavior is based on fear. This is inappropriate practice [professional practice] for the patient. The resident is thinking how to avoid errors, to prevent a negative response from the supervisor. This generates greater stress for the resident ... The resident acts defensively and not proactively in the patient’s favor. (Interview #4: 3rd-year female resident) "These supervisors are focused on the error and do not give feedback to the resident ... so the resident keeps making mistakes. That is not a good way to teach." (Interview #6: 4th-year male resident) I do not want to be like that person [the supervisor]. I do not want that life for me. If you see that your supervisor is rude, bad-tempered, someone who is not able to control his/her anger (such people almost always have personal problems, divorces, and do not spend enough time at home), the resident may say: "this is not the life that I want in the future!" So, the resident leaves the program. (Interview #3: 3rd-year male resident)
Laissez-faire Many supervisors are passive leaders, many of them spend time with residents because it is their obligation. Although they are part of a surgical team, they are not real supervisors, they are not interested [in residents’ education] ... They are indolent and indifferent to the resident ..., so there is no real connection between supervisor and resident ... It is not an enriching environment for learning. (Interview #11: 2nd-year female resident) Residents cannot control the environment well because the supervisor simply leaves the resident alone, does not supervise anything that the resident is doing ... does not teach him/her anything. He/she [the supervisor] does not care if the resident is doing things right or wrong. He/she simply leaves the resident to his own devices. (Interview #13: 4th-year female resident) If you have a disinterested, a passive supervisor who does the minimum required to fulfill, you are getting a bad model. Very little profit is taken from them, because they do not commit, do not make decisions and do not take appropriate care of situations ... They simply expend the least effort possible. (Interview #12: 4th-year male resident)
Int J Med Educ. 2022; 13:74-83; doi: 10.5116/ijme.622d.e2f6