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

Farnan, Jeanne M.; Johnson, Julie K.; Meltzer, David O.; Harris, Ilene B.; Humphrey, Holly J.; Schwartz, Alan; Arora, Vineet M.

doi:10.4300/jgme-d-09-00015.1

Cited by 38 publications

(40 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of note, residents also place a high value on knowing the specific circumstances in which communication with supervisors is expected [63]. By creating a standard process in which real-time communication with supervising physicians was expected to occur for all MICU consults, regardless of MICU admission status, we avoided the uncertainty residents may have previously had regarding when to call.…”

Section: Discussionmentioning

confidence: 99%

Intermediate care to intensive care triage: A quality improvement project to reduce mortality

Hager

Chandrashekar

Bradsher

et al. 2017

Journal of Critical Care

View full text Add to dashboard Cite

Purpose Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur. Methods To improve our triage process, we used a 4Es quality improvement framework (engage, educate, execute, evaluate) to (1) educate residents and fellows regarding principles of triage and (2) facilitate real-time communication between MICU residents conducting triage and supervising physicians. Results Among patients transferred from the IMCU to the MICU during baseline (n=83; July–December 2012) and intervention phases (n=94; July–December 2013), unadjusted mortality decreased from 34% to 21% (p=0.06). After adjusting for severity of illness, admitting diagnosis, and bed availability, the odds of death were lower during the intervention vs. baseline phase (OR 0.33; 95%CI 0.11–0.98). Conclusions Using a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.

show abstract

Section: Discussionmentioning

confidence: 99%

Intermediate care to intensive care triage: A quality improvement project to reduce mortality

Hager

Chandrashekar

Bradsher

et al. 2017

Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…3,6,7 However, the hidden curriculum of supervision may praise and reward residents for carrying heavy patient loads without calling for help. 6 Residents who do call for help from their attending physicians are often perceived as weak.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,8,9 Early in their training, interns are driven by 2 main influences that minimize notification of their supervising physicians when they are uncertain. 7,10,11 Making calls, even to the attending physician, interrupts other team members, disrupts the workflow of the team, and decreases team efficiency. In addition, residents want to gain approval from their supervisors.…”

Section: Discussionmentioning

confidence: 99%

“Page Me if You Need Me”: The Hidden Curriculum of Attending-Resident Communication

Loo¹,

Puri²,

Kim³

et al. 2012

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Background Discrepancies exist between what resident and attending physicians perceive as adequate supervision. We documented current practices in a university-based, categoric, internal medicine residency to characterize these discrepancies and the types of mixed messages that are communicated to residents, as well as to assess their potential effect on resident supervision and patient safety. Methods We surveyed residents and attending physicians separately about their current attitudes and behaviors regarding resident supervision. Both groups responded to 2 different measures of resident supervision: (1) 6 clinical vignettes that involved patient safety concerns, and (2) 9 frequently reported phrases communicated by attending physicians to residents before leaving the hospital during on-call admission days. Results There were clear and substantial differences between the perceptions of resident and attending physicians about when the supervising attending physician should be notified in each of the 6 vignettes. For example, 85% of attending physicians reported they wanted to be notified of an unexpected pneumothorax that required chest tube placement, but only 31% of resident physicians said they would call their attending physician during those circumstances. Common phrases, such as “page me if you need me,” resulted in approximately 50% of residents reporting they would “rarely” or “never” call and another 41% reporting they would only “sometimes” call their attending physicians. Conclusions Our study found that attending physicians reported they would want more frequent communication and closer supervision than routinely perceived by resident physicians. Although this discrepancy exists, commonly used phrases, such as “page me if you need me,” rarely resulted in a change in resident behavior, and attending physicians appeared to be aware of the ineffectiveness of these statements. These mixed messages may increase the difficulty of balancing the dual goals of appropriate attending supervision and progressive independence during residency training.

show abstract

“…6,[11][12][13] The discussion highlights a patient safety perspective brought forth by the mother and allows for dialogue concerning existing communication and supervision barriers in the delivery of safe patient care and thoughts on improvement strategies. [14][15][16] Much of medical training is focused on the acquisition of knowledge and skills; however, it is the affective domain of learning that is responsible for changing behaviors. 17,18 The affective domain refers to attitudes, beliefs, values, feelings, and emotions.…”

Section: Discussionmentioning

confidence: 99%

Mainstreaming Risk Management Education Into New Resident and Fellow Orientation

McMyler¹,

Ross²,

Saran³

et al. 2011

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Introduction Understanding patient safety events and causative factors is an important step in reducing preventable adverse events. The University of Michigan's Graduate Medical Education (GME) Office, Department of Risk Management (DRM), and Office of Clinical Affairs (OCA) collaborated to incorporate a video workshop as a formal introduction to patient safety during orientation for new residents and fellows. This workshop reinforced the importance of effective communication and supervision in patient safety. Methods DRM and OCA produced a video depicting an actual, unanticipated outcome that resulted from a constellation of preventable circumstances, which allows the audience to observe communication and supervision issues that lead to a patient death. The video is followed by a discussion of the patient safety issues seen, why they occurred, and strategies for improvement. Trainee perceptions of the value of the experience were surveyed and collected using a qualitative survey. Results Most responders found the video workshop helpful. Trainees perceived the video and facilitated discussion as an effective way to identify patient safety issues, available resources, and the culture of patient safety at the institution. Conclusion Trainee comments supported the video workshop as an effective way to highlight the importance of communication and supervision in relation to patient safety. In the future, the DRM, OCA, and GME hope to reinforce this shared vision of patient safety through combined educational efforts.

show abstract

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

Cited by 38 publications

References 24 publications

Intermediate care to intensive care triage: A quality improvement project to reduce mortality

Intermediate care to intensive care triage: A quality improvement project to reduce mortality

“Page Me if You Need Me”: The Hidden Curriculum of Attending-Resident Communication

Mainstreaming Risk Management Education Into New Resident and Fellow Orientation

Contact Info

Product

Resources

About