Loo Lawrence, Puri Nishant, Kim Daniel I, Kawayeh Anas, Baz Samuel, Hegstad Douglas
J Grad Med Educ. 2012 Sep;4(3):340-5. doi: 10.4300/JGME-D-11-00175.1.
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.
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.
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.
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.
住院医师和主治医师对于充分监督的认知存在差异。我们记录了一所大学附属医院内科住院医师培训项目中的当前做法，以描述这些差异以及传达给住院医师的混合信息类型，并评估其对住院医师监督和患者安全的潜在影响。
我们分别调查了住院医师和主治医师对当前住院医师监督的态度和行为。两组人员对两种不同的住院医师监督衡量标准做出回应：（1）6个涉及患者安全问题的临床案例；（2）9条主治医师在值班入院日离开医院前经常对住院医师说的话。
在6个案例中，住院医师和主治医师对于何时应通知监督主治医师的看法存在明显且重大的差异。例如，85%的主治医师表示，他们希望在遇到需要放置胸管的意外气胸情况时得到通知，但只有31%的住院医师表示在这种情况下会呼叫他们的主治医师。常见表述，如“如果你需要我就呼我”，导致约50%的住院医师表示他们“很少”或“从不”呼叫，另有41%的住院医师表示他们只会“有时”呼叫主治医师。
我们的研究发现，主治医师表示他们希望比住院医师通常认为的更频繁地沟通和更密切地监督。尽管存在这种差异，但常用表述，如“如果你需要我就呼我”，很少导致住院医师行为的改变，而且主治医师似乎意识到了这些表述的无效性。这些混合信息可能会增加在住院医师培训期间平衡适当的主治医师监督和逐步独立这两个双重目标的难度。
