Increasing direct attending supervision and participation during work rounds did not significantly impact the rate of medical errors or patient safety; rather it hindered resident education, according to research published in JAMA Internal Medicine.
“While the relationship between resident work hours and patient safety has been extensively studied, little research has evaluated the role of attending physician supervision on patient safety,” Kathleen M. Finn, MD, from Massachusetts General Hospital, and colleagues wrote.
Finn and colleagues conducted a randomized clinical trial to investigate how increasing attending physician supervision affects patient safety and educational outcomes for an inpatient resident general medical service.
The trial included 22 attending physicians who provided either increased direct supervision in which they joined work rounds or standard supervision in which they were available but did not join work rounds. Physicians provided both forms of supervision in random order. They attended to a total of 1,259 patients. Most physicians (68%) had more than 5 years of experience.
The researchers found that the medical error rates for standard and increased supervision did not significantly differ (107.6 per 1,000 patient-days [95% CI, 85.8-133.7] vs. 91.1 per 1,000 patient-days [95% CI, 76.9-104]).
The mean length of time spent discussing established patients during work rounds was similar in both groups (202 minutes [95% CI, 192-212] vs. 202 minutes [95% CI, 189-215]). When attending physicians joined work rounds, interns tended to speak less (64 minutes [95% CI, 60-68] vs. 55 minutes [95%CI, 49-60]) and reported feeling less efficient and less autonomous. Residents also reported feeling less autonomous when attending physicians joined work rounds.
Attending physicians believed the quality of care was higher when they joined work rounds.
“Given the importance of graduated autonomy to adult learning and the value of peer learning, the decisions about level of supervision should consider the need for distance between teacher and student for learning to occur,” Finn and colleagues concluded. “The results of this study suggest that residency training programs reconsider the appropriate level of attending physician supervision in designing their morning rounds, balancing patient safety, excellent care, learner needs, and resident autonomy.” – by Alaina Tedesco
Finn reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.