Clinical question: What is the effect of increasing attending physician supervision on a resident inpatient team for both patient safety and education?
Background: Residents need autonomy to help develop their clinical skills and to gain competence to practice independently; however, there is rising concern that increased supervision is needed for patient safety.
Study Design: Randomized, crossover clinical trial.
Setting: 1,100-bed academic medical center at Massachusetts General Hospital, Boston.
Dr. Claire Ciarkowski
Synopsis: Twenty-two attending physicians participated in the study over 44 2-week teaching blocks with a total of 1,259 patient hospitalizations on the general medicine teaching service. In the intervention arm, attendings were present during work rounds; in the control arm, attendings discussed established patients with the resident via card flip. New patients were discussed at the bedside in both arms. There was no statistically significant difference in the number of medical errors or patient safety events between the two groups. Residents in the intervention group, however, felt less efficient and autonomous and were less able to make independent decisions. Limitations include this being a single-center study at a program emphasizing resident autonomy and therefore may limit generalizability. Current literature on supervision and patient safety has variable results. This study suggests that increasing attending supervision may not increase patient safety, but may negatively affect resident education and autonomy.
Bottom line: Attending physician presence on work rounds does not improve patient safety and may have deleterious effects on resident education.
Citation: Finn KM et al. Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education. JAMA Intern Med. 2018;178(7):925-59
Dr. Ciarkowski is clinical instructor of medicine and an academic hospitalist, University of Utah, Salt Lake City.