Emergency Department, St Vincent's Hospital, Fitzroy, Victoria, Australia.
BMC Med Educ. 2010 Nov 2;10:74. doi: 10.1186/1472-6920-10-74.
Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs) and perceived feedback provided.
Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes.
Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1%) granted interviews including 100% (36/36) of ED Directors, and 96.2% (25/26) of eligible DEMTs, 24% (19/81) of advanced trainee/registrars, and 17% (15/90) of interns. Most participants (61%) felt the ED was adequately supervised in general and (64.2%) that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64%) and junior staff (79%) agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback.
Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.
临床监督和反馈对于初级医生能力的发展很重要。本研究旨在确定澳大利亚急诊科（ED）中初级医务人员监督的充分性和感知到的反馈情况。
通过半结构化电话调查，从 37 家具有代表性的澳大利亚医院的 ED 主任、急诊医学培训主任、住院医师和实习医生那里获取定量和定性数据；使用 SPSS 15.0 分析定量数据，对定性数据进行内容分析，确定主题。
37 家医院中有 36 家参与了研究。在 233 名潜在受访者中，有 95 名（40.1%）接受了采访，包括 100%（36/36）的 ED 主任和 96.2%（25/26）的急诊医学培训主任、24%（19/81）的高级受训者/住院医师和 17%（15/90）的实习医生。大多数参与者（61%）认为 ED 的总体监督是充分的，（64.2%）认为医务人员的监督是充分的。顾问和住院医师被认为为实习医生提供了大部分监督，但这取决于轮班时间，注册医生更有可能在夜班和周末提供监督。高级 ED 医疗人员（64%）和初级工作人员（79%）认为实习医生接受了充分的临床监督。定性分析表明，已经制定了良好的流程来确保充分的监督，但服务需求，特别是与通道阻塞和过度拥挤有关的需求，对监督和反馈都有不利影响。
在澳大利亚 ED，顾问似乎为初级医务人员提供了大部分监督。监督和反馈通常被认为是充分的，但受到服务需求的威胁，特别是与通道阻塞和 ED 过度拥挤有关的需求。
