Ross Paula T, McMyler Eileen T, Anderson Susan G, Saran Kelly A, Urteaga-Fuentes Anabel, Boothman Richard C, Lypson Monica L
Department of Health Behavioral and Health Education, School of Public Health University of Michigan, Ann Arbor, Michigan, USA.
Jt Comm J Qual Patient Saf. 2011 Feb;37(2):88-95. doi: 10.1016/s1553-7250(11)37011-0.
Ensuring that trainees receive appropriate clinical supervision is one proven method for improving patient safety outcomes. Yet, supervision is difficult to monitor, even more so during advanced levels of training. The manner in which trainees' perceived failures of supervision influenced patient safety practices across disciplines and various levels of training was investigated.
A brief, open-ended questionnaire, administered to 334 newly hired interns, residents, and fellows, asked for descriptions of situations in which they witnessed a failure of supervision and their corresponding response.
Of the 265 trainees completing the survey, 73 (27.5%) indicated having witnessed a failure of supervision. The analysis of these responses revealed three types of supervision failures-monitoring, guidance, and feedback. The necessity of adequate supervision and its accompanying consequences were also highlighted in the participants responses.
The findings of this study identify two primary sources of failures of supervision: supervisors' failure to respond to trainees' seeking of guidance or clinical support and trainees' failure to seek such support. The findings suggest that the learning environment's influence was sufficient to cause trainees to value their appearance to superiors more than safe patient care, suggesting that trainees' feelings may supersede patients' needs and jeopardize optimal treatment. The literature on the impact of disruptive behavior on patient care may also improve understanding of how intimidating and abusive behavior stifles effective communication and trainees' ability to provide optimal patient care. Improved supervision and communication within the medical hierarchy should not only create more productive learning environments but also improve patient safety.
确保实习生接受适当的临床监督是提高患者安全结果的一种经证实的方法。然而，监督很难进行监测，在高级培训阶段更是如此。本研究调查了实习生所感知到的监督失败对跨学科和不同培训水平的患者安全实践的影响方式。
对334名新入职的实习生、住院医师和研究员进行了一项简短的开放式问卷调查，询问他们所目睹的监督失败情况及其相应反应的描述。
在完成调查的265名实习生中，73人（27.5%）表示目睹过监督失败。对这些回答的分析揭示了三种监督失败类型——监测、指导和反馈。参与者的回答中还强调了充分监督的必要性及其附带后果。
本研究结果确定了监督失败的两个主要根源：上级未能回应实习生寻求指导或临床支持的请求，以及实习生未能寻求此类支持。研究结果表明，学习环境的影响足以使实习生更看重自己在上级眼中的形象而非患者的安全护理，这表明实习生的感受可能会取代患者的需求并危及最佳治疗。关于破坏性行为对患者护理影响的文献也可能有助于更好地理解恐吓和辱骂行为如何抑制有效沟通以及实习生提供最佳患者护理的能力。改善医疗层级内的监督和沟通不仅应营造更具成效的学习环境，还应提高患者安全。
