The role of medical residents’ peer networks in clinical decision making: A constructivist grounded theory study

INTRODUCTION: The literature exploring how and why medical residents seek clinical advice has centered the formal resident-supervisor relationship, with the informal role of peers remaining underexplored. METHOD: Using constructivist grounded theory (CGT) methodology, we purposively sampled Internal Medicine/General Internal Medicine residents from a Canadian medical school from April-June 2023. We conducted semi-structured interviews, exploring how and why advice was sought from peers. We analyzed data iteratively, incorporating critical theory into the analysis to attend to the role of hierarchy and agency shaping social processes around peer advice seeking. RESULTS: Ten residents participated. Participants described peer advice seeking as a widespread phenomenon, usually performed without disclosure to supervisors. Peer advice was primarily sought in situations of clinical uncertainty, wherein patient safety was not felt to be immediately threatened. The psychological safety of peers allowed residents to exercise agency in their decision making and maintain credibility with their supervisors. DISCUSSION: Participants in this study frequently seek advice from informal peer networks when navigating clinical uncertainty. Peer advice is used to manage uncertainty and to maintain credibility with supervisors. The ubiquity of peer advice seeking challenges the construct of 'progressive independence.' Future research can identify how supervisors may model and respond to peer advice seeking.