Measuring Progressive Independence With the Resident Supervision Index: Empirical Approach

Abstract

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.

The role of role: learning in longitudinal integrated and traditional block clerkships

“…Our students’ perceptions of their own greater efficacy and autonomy later in the clerkship year are consistent with the tenets of guided learning, in which learners are afforded progressively greater independence with patients over time 17 . Learners highly value this progressive independence, which they can experience in clinical settings 31 . In our study, BC students did not describe a similar progression in the amount of independent responsibility they were allowed.…”

“…17 Learners highly value this progressive independence, which they can experience in clinical settings. 31 In our study, BC students did not describe a similar progression in the amount of independent responsibility they were allowed. We suspect that the absence of this experience for BC students derives from the fact that their supervisors do not come to know them well enough or for long enough to gauge their skills, abilities and learning needs.…”

Measuring Progressive Independence With the Resident Supervision Index: Theoretical Approach

“…The theoretical score is equivalent to the summary patient care encounter score [RSI care ], as operationally defined elsewhere. 1 …”

“…Specifically, theory makes explicit all of the underlying assumptions necessary for statistical inferences from data analyses, provides the basis to define optimal supervision, and offers frameworks to develop guidelines that can help teaching staff balance patient care needs with resident education demands. Theory is used to derive hypotheses, develop analytic models to test those hypotheses, and guide formulation of intensity scores 1 and collection of GME data. 2 …”

How do attendings perceive housestaff autonomy? Attending experience, hospitalists, and trends over time

“…Entrustable Professional Activities are benchmarks by which resident readiness to progress through training will be judged . The extent to which trainees are entrusted with autonomy is largely determined by the subjective assessment of immediate supervisors, as autonomy is rarely measured or quantified . This judgment of autonomy, most frequently performed by ward attendings, may be subject to significant variation and influenced by factors other than the resident's competence and clinical abilities.…”