Miller Kelsey A, Collada Beatriz, Tolliver Destiny, Audi Zeena, Cohen Amy, Michelson Catherine, Newman Lori R
Department of Medicine (KA Miller, Z Audi), Boston Children's Hospital, Boston, Ma.
Department of Pediatrics (B Collada, D Tolliver, C Micheson), Boston University School of Medicine, Boston Ma.
Acad Pediatr. 2020 Jan-Feb;20(1):89-96. doi: 10.1016/j.acap.2019.07.012. Epub 2019 Aug 9.
Consensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.
Use modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist.
DESIGN/METHODS: One hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors' inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if >25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals.
After 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed.
CONCLUSION(S): Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.
对于儿科住院查房时上级住院医师对下级住院医师进行有效监督的行为，目前尚无共识。
采用改良德尔菲法制定一份清单，列出儿科住院医师在主持非重症监护病房、非专科的住院教学查房时应具备的基本监督行为，并对该清单进行试点。
设计/方法：通过文献回顾确定了141项初始候选行为，并由当地利益相关者进行筛选。将41项行为提交给通过目的抽样确定的全国专家，采用改良德尔菲法进行完善。参与者表明是否同意将这些行为纳入清单，以及是否存在无法观察到的行为。使用集中趋势和离散度测量方法来确定在下一轮中对某项行为纳入清单的共识。如果超过25%的专家认为某项行为无法观察到，则将其剔除。循环持续进行，直到就≤20项行为达成共识。最终形成的清单在两家医院进行了试点。
经过两轮改良德尔菲法，就18项行为达成共识并纳入最终清单。这些行为分布在三个子类别中：教学、领导能力和患者安全。在试点中，该行为清单能够区分住院查房时不同监督能力水平的住院医师。对于由两名教员完成清单的住院医师，观察到的行为中有75%达成了一致。
基于文献回顾、当地利益相关者意见以及全国专家通过改良德尔菲法达成的共识，我们创建并试点了一份清单，列出了儿科住院医师在带领实习团队进行非重症监护病房、非专科住院查房时有效临床监督的可观察行为特征。
