Clinical Oversight: Conceptualizing the Relationship Between Supervision and Safety

Kennedy, Tara J T; Lingard, Lorelei; Baker, G. Ross; Kitchen, Lisa; Regehr, Glenn

doi:10.1007/s11606-007-0179-3

Cited by 181 publications

(182 citation statements)

References 28 publications

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“…The perspectives on ideal or effective supervision may reflect institutional culture and norms and may not adequately and objectively represent more generally applicable elements of effective clinical supervision. However, given the congruence between our qualitative results and previously collected qualitative data related to clinical supervision 13 we expect that these findings will be applicable to clinical supervision at other institutions. There were also many common themes identified by both resident and attending physician describing ideal behaviors.…”

Section: Limitationssupporting

confidence: 75%

Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

Farnan¹,

Johnson²,

Meltzer³

et al. 2010

Journal of Graduate Medical Education

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Background Supervision is central to resident education and patient safety, yet there is little published evidence to describe a framework for clinical supervision. The aim of this study was to describe supervision strategies for on-call internal medicine residents. Methods Between January and November 2006, internal medicine residents and attending physicians at a single hospital were interviewed within 1 week of their final call on the general medicine rotation. Appreciative inquiry and critical incident technique were used to elicit perspectives on ideal and suboptimal supervision practices. A representative portion of transcripts were analyzed using an inductive approach to develop a coding scheme that was then applied to the entire set of transcripts. All discrepancies were resolved via discussion until consensus was achieved. Results Forty-four of 50 (88%) attending physicians and 46 of 50 (92%) eligible residents completed an interview. Qualitative analysis revealed a bidirectional model of suggested supervisory strategies, the “SUPERB/SAFETY” model; an interrater reliability of 0.70 was achieved. Suggestions for attending physicians providing supervision included setting expectations, recognizing uncertainty, planning communication, having easy availability, reassuring residents, balancing supervision, and having autonomy. Suggested resident strategies for seeking supervision from attending physicians included seeking input early, contacting for active clinical decisions or feeling uncertain, end of life issues, transitions in care, or help with systems issues. Common themes suggested by trainees and attending physicians included easy availability and preservation of resident decision-making autonomy. Discussion Residents and attending physicians have explicit expectations for optimal supervision. The SUPERB/SAFETY model of supervision may be an effective resource to enhance the clinical supervision of residents.

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Section: Limitationssupporting

confidence: 75%

Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

Farnan¹,

Johnson²,

Meltzer³

et al. 2010

Journal of Graduate Medical Education

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“…Quantifying supervision and measuring progressive responsibility have policy implications for defining supervision standards and measuring GME educational outcomes. 14 Building on previous work, [1][2][3]15 the RSI method consists of a survey instrument (RSI Inventory), 8 scoring strategy (presented herein), theoretical framework (patient-centered optimal supervision), 9 and analytic framework (2-part model). 9 This article shows how RSI Inventory responses were scored to quantify different levels of supervision intensity that, taken together, profile supervision during encounters among residents, attending physicians, and patients in outpatient care settings.…”

Section: Discussionmentioning

confidence: 99%

“…Our data provide support for the RSI method by showing intensity scores covarying with resident experience, complexity of patient cases, clinic workload, and attending physician characteristics, consistent with the patient-centered theory of optimal supervision. Supervision has often been described as an oversight function designed to ensure the quality of care 15,16 and measured by whether the attending physician made a medical chart notation, 17 was physically present, 18 was involved, 19,20 identified discrepancies, 21 or participated on the health team.…”

Section: Discussionmentioning

confidence: 99%

Measuring Progressive Independence With the Resident Supervision Index: Empirical Approach

Kashner¹,

Byrne²,

Chang³

et al. 2010

Journal of Graduate Medical Education

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Background A Resident Supervision Index (RSI) developed by our research team quantifies the intensity of resident supervision in graduate medical education, with the goal of testing for progressive independence. The 4-part RSI method includes a survey instrument for staff and residents (RSI Inventory), a strategy to score survey responses, a theoretical framework (patient centered optimal supervision), and a statistical model that accounts for the presence or absence of supervision and the intensity of patient care.

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“…There is no numerical threshold for the number of participants that may result in theoretical saturation. In Weed's (2005) study of the policy process for sport and tourism it was 25, whereas in Kennedy et al's (2007) study of clinical oversight in hospital emergency departments it was 88. An analysis should be interrogated for theoretical saturation during each iteration, and it is reached when gathering data and the ongoing process of constant comparison no longer brings fresh theoretical insights or enhances or extends higher level concepts (Charmaz, 2006).…”

Section: Methodsologymentioning

confidence: 99%

Capturing the essence of grounded theory: the importance of understanding commonalities and variants

Weed

2016

Qualitative Research in Sport, Exercise and Health

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This paper aims to capture the essence of grounded theory (GT) by setting out its commonalities and variants and, importantly, the implications of the latter for the implementation of the former, and for the truth claims and the contributions to knowledge that a GT study might make. Firstly, three ontological and epistemological variants of GT are outlined. Secondly, the commonalities of GT are set out as eight core elements of GT methodology that are individually necessary, but only sufficient collectively, to define a GT study. These elements are: an iterative process; theoretical sampling; theoretical sensitivity; codes, memos and concepts; constant comparison; theoretical saturation; fit, work, relevance and modifiability; and substantive theory. Thirdly, the implications of the ontological and epistemological variants of GT for, firstly, the implementation of the core common elements of the methodology and, secondly, the truth claims and contributions to knowledge that might be made, are discussed. Finally, the paper concludes by arguing that published GT studies in sport, exercise and health research have not always explicitly demonstrated a full understand of the commonalities and variants of GT, and that researchers publishing GT studies must take responsibility for doing this.

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Clinical Oversight: Conceptualizing the Relationship Between Supervision and Safety

Cited by 181 publications

References 28 publications

Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

Measuring Progressive Independence With the Resident Supervision Index: Empirical Approach

Capturing the essence of grounded theory: the importance of understanding commonalities and variants

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