Rethinking resident supervision to improve safety: from hierarchical to interprofessional models.
Approach to Improving Safety
- Audit and Feedback
- Communication between Providers
- Duty Hour Limitation
- Culture of Safety
- Residents and Fellows
Setting of Care
Inadequate supervision of resident physicians has been recognized as a potential patient safety hazard for decades. The Accreditation Council for Graduate Medical Education emphasized the importance of proper supervision in the 2011 duty hour regulations, implementing specific rules mandating closer supervision for first-year residents. However, there remains surprisingly little empirical research on effective supervision models. This qualitative study of residents during an intensive care unit rotation found that the authority gradient significantly affected residents' decisions to seek supervision and feedback from superiors. Residents did report benefiting from nonjudgmental feedback and advice from clinicians from other disciplines, principally nurses and pharmacists. Residents agreed that regardless of discipline, clinicians who used nonjudgmental language were much more effective supervisors and teachers. This study provides a novel perspective on the relationship between safety culture and resident supervision.