Department of Medicine, Division of General Internal Medicine, The George Washington University, 2150 Pennsylvania Avenue, NW - Suite 5-416, Washington, DC, 20037, USA.
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
J Gen Intern Med. 2021 Jul;36(7):1974-1979. doi: 10.1007/s11606-020-06516-4. Epub 2021 Jan 28.
Single-center studies have reported residents experience barriers to accessing supervising physicians overnight, but no national dataset has described barriers perceived by residents or the association between supervision models and perceived barriers.
To explore residents' perception of barriers to accessing overnight supervision.
Questions about overnight supervision and barriers to accessing it were included on the American College of Physicians Internal Medicine In-Training Examination® (IM-ITE®) Resident Survey in Fall 2017.
All US-based internal medicine residents who completed the 2017 IM-ITE®. Responses from 20,744 residents (84%) were analyzed.
For our main outcome, we calculated percentages of responses for eight barriers and tested for association with the presence or absence of nocturnists. For our secondary outcome, we categorized free-text responses enumerating barriers from all residents into the five Systems Engineering Initiative for Patient Safety (SEIPS) categories to elucidate future areas for study or intervention.
Internal medicine residents working in hospitals without nocturnists more commonly reported having at least one barrier to accessing a supervising physician "always" or "most of the time" (5075/9842, 51.6%) compared to residents in hospitals with nocturnists (3074/10,902, 28.2%, p < 0.001). Among residents in hospitals without nocturnists, the most frequently reported barrier to accessing attending supervision was attendings not being present in the hospital (30.4% "always" or "most of the time"); residents in hospitals with nocturnists most frequently reported desire to make their own decisions as a barrier to contacting attendings (15.7% "always" or "most of the time"). Free-text responses from residents with and without nocturnists most commonly revealed organization (47%) barriers to accessing supervision; 28% cited person barriers, and 23% cited tools/technology barriers.
Presence of nocturnists is associated with fewer reported barriers to contacting supervising physicians overnight. Organizational culture, work schedules, desire for independence, interpersonal interactions, and technology may present important barriers.
单中心研究报告称，住院医师在夜间获得主治医生的监督存在障碍，但尚无全国性数据集描述住院医师认为的障碍，以及监督模式与感知障碍之间的关联。
探讨住院医师对夜间监督的看法。
2017 年秋季，在美国医师学院内科住院医师培训在线考试（IM-ITE®）住院医师调查中纳入了有关夜间监督和获得监督障碍的问题。
所有完成 2017 年 IM-ITE®的美国内科住院医师。分析了 20744 名住院医师（84%）的回复。
我们计算了 8 个障碍的回复百分比，并测试了它们与是否存在夜班医生之间的关联。对于我们的次要结果，我们将所有住院医师列举的障碍的自由文本回复分类为五个患者安全系统工程倡议（SEIPS）类别，以阐明未来的研究或干预领域。
与有夜班医生的医院相比，在没有夜班医生的医院工作的内科住院医师更常报告“总是”或“大部分时间”存在至少一种获得主治医生监督的障碍（5075/9842，51.6%）比在有夜班医生的医院（3074/10902，28.2%，p<0.001）。在没有夜班医生的医院的住院医师中，最常报告的获得主治医生监督的障碍是主治医生不在医院（30.4%“总是”或“大部分时间”）；在有夜班医生的医院的住院医师最常报告自主决策的愿望是联系主治医生的障碍（15.7%“总是”或“大部分时间”）。有和没有夜班医生的住院医师的自由文本回复最常揭示监督的获取障碍；47%为组织障碍，28%为人为障碍，23%为工具/技术障碍。
夜班医生的存在与夜间联系主治医生的报告障碍较少有关。组织文化、工作安排、独立愿望、人际互动和技术可能是重要的障碍。
