The Role of Attribution to Clerk Factors and Contextual Factors in Supervisors' Perceptions of Clerks' Behaviors

BACKGROUND: Novice clinical clerks are expected to integrate smoothly into a medical team, often with little guidance. PURPOSE: To explore medical residents' and attendings' perceptions of clerk behaviors that may aid or hinder this integration. METHODS: Three resident focus groups and 5 attending staff interviews were conducted. Transcripts were analyzed using grounded theory. RESULTS: One hundred thirty-seven instances of clerk behaviors were identified. Many similar behaviors were alternately perceived as positive or negative, depending critically on 2 dimensions the clerk (speculated motives or personality traits) or the context (timing of behavior or clerk's stage of training). Motives and traits were mentioned nearly 3 times as often as contextual factors, possibly reflecting the fundamental attribution error, as described in social psychology. Supervisors' perceptions of why or when a behavior was enacted were an important factor in their perceptions. CONCLUSIONS: With explicit discussion of this phenomenon, supervisors' judgments might suffer from fewer biases, and students' integration into the team and profession might occur with less ambiguity and stress.