Guest Author: Heather Hartman-Hall, PhD, Senior Director, Wellbeing and Mental Health, Medstar Health
One common challenge for clinical faculty is balancing the sometimes opposing needs of patients and trainees. This can take many forms, including balancing optimal patient care with the learner’s level of competence, balancing the emotional needs of patients and learners during stressful or emotionally charged encounters, and balancing patient privacy with the learner’s need for experiential learning on sensitive topics such as assault or trauma.
Self-Determination Theory (SDT) offers a helpful framework for considering the balance of learner and patient needs. SDT identifies three main psychological needs for maximizing learner performance (and wellbeing): autonomy, competence, and relatedness. Importantly, autonomy should not be considered synonymous with independence; while independence is more specifically related to freedom from constraints, autonomy implies a sense of personal agency that can occur in independent and dependent contexts. Sometimes in our complex clinical learning environments, learner independence may need to be limited – but learner autonomy can be preserved. In fact, with the right framing, even activities considered frustrating or undesirable can promote a sense of meaningfulness.
Neufeld and Rigby (2024) suggest three ways to promote a sense of autonomy in medical learners:
Give a meaningful rationale,
Address negative effects, such as resistance or frustration, directly, and
Provide a sense of choice when possible.
We all share the goal of keeping patient care at the center of our approach while giving learners the appropriate level of responsibility. Hearn et al. (2019) suggest a useful guiding principle: educational activities should be about the patient, with the patient, and for the patient, so that teaching never feels separate from care delivery. In practice, this means asking, “What does this patient need most right now?” and then identifying how learners can be involved based on their competency level. Even when clinical emergencies limit direct educational opportunities, intentional teaching and trainee inclusion can maintain learner engagement and autonomy.
Challenges in balancing patient needs with the learning needs of medical trainees may arise in other circumstances, such as unsafe or intolerable patient behaviors, or extreme learner fatigue requiring a transition of care, which may necessitate more specific support and intervention by faculty members. As always, the physical and psychological safety of our learners is paramount to our ethical and educational responsibilities. Stay tuned for a future Medical Educator Minute column to learn more about creating psychological safety in the clinical learning environment.
To learn more, check out these articles:
Neufeld AP, Rigby CS. Autonomy Versus Independence: Implications for Resident and Faculty Engagement, Performance, and Well-Being. HCA Healthc J Med. 2024;5(3):209-213. Published 2024 Jun 1.
Hearn J, Dewji M, Stocker C, et al. Patient-centered Medical Education: A Proposed Definition. Med Teach. 2019;41(8):934-938.
Neufeld A, Guldner G. Supporting Basic Psychological Needs in Medical Education: A Patient Best Practice. Perspect. Med. Educ. 2026;15(1): 343-350.
Jimenez SR. Balancing Preceptorship with Clinical Practice: A Guide for Physician Preceptors. ACOFP Voice. Published November 1, 2024. Accessed May 12, 2026.