Measuring Progressive Independence With the Resident Supervision Index: Theoretical Approach

Abstract

Background Graduate medical education is based on an onthe-job training model in which residents provide clinical care under supervision.The traditional method is to offer residents graduated levels of responsibility that will prepare them for independent practice. However, if progressive independence from supervision exceeds residents' progressive professional development, patient outcomes may be at risk. Leaders in graduate medical education have called for ''optimal'' supervision, yet few studies have conceptually defined what optimal supervision means and whether optimal care is

Measuring Progressive Independence With the Resident Supervision Index: Empirical Approach

“…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.…”

“…Our theoretical framework is based on the assumption that attending physicians are fully informed about the case (oversight) when supervising residents for care discussions and patient services. 9 We thus compute patient care responsibility [RSI resp ] after staff oversight as follows:…”

“…9 An exhaustive search was used within each covariate category to identify potential confounders. 13 With complex 4-way interactions between resident, attending physician, patient, and clinic shift, we assumed that supervision intensity was independently distributed over 140 encounters.…”

“…A prior article has described the feasibility and psychometric reliability of the RSI Inventory as a survey instrument to collect supervision information from attending staff and residents (APPENDIX 1), 8 and in the companion article published in this issue of Journal of Graduate Medical Education, we describe the theory of patient-centered optimal supervision and derive the 2-part analytic models designed to test theory-driven hypotheses. 9 In this article, we introduce the final part of the 4-part RSI method by describing how RSI Inventory responses are scored to compute supervision intensity.…”

“…The RSI method is evaluated by testing 3 RSI theory-driven hypotheses, derived elsewhere, 9 in chart, consulted with staff, or assessed patient). Scores are analyzed by level and for patient care using a 2-part model (supervision initiated [yes or no] versus intensity once supervision was initiated).…”