Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Oct;6(8):445-52.
doi: 10.1002/jhm.919.

Rethinking resident supervision to improve safety: from hierarchical to interprofessional models

Michal Tamuz  1 , Traber Davis Giardina, Eric J Thomas, Shailaja Menon, Hardeep Singh
Affiliations

Rethinking resident supervision to improve safety: from hierarchical to interprofessional models

Michal Tamuz et al. J Hosp Med. 2011 Oct.

Abstract

Background: Inadequate supervision is a significant contributing factor to medical errors involving trainees, but supervision in high-risk settings such as the intensive care unit (ICU) is not well studied.

Objective: We explored how residents in the ICU experienced supervision related to medication safety, not only from supervising physicians but also from other professionals. DESIGN, SETTING, MEASUREMENTS: Using qualitative methods, we examined in-depth interviews with 17 residents working in ICUs of three tertiary-care hospitals. We analyzed residents' perspectives on receiving and initiating supervision from physicians within the traditional medical hierarchy, and from other professionals, including nurses, staff pharmacists, and clinical pharmacists ("interprofessional supervision").

Results: While initiating their own supervision within the traditional hierarchy, residents believed in seeking assistance from fellows and attendings, and articulated rules of thumb for doing so; however, they also experienced difficulties. Some residents were concerned that their questions would reflect poorly on them; others were embarrassed by their mistaken decisions. Conversely, residents described receiving interprofessional supervision from nurses and pharmacists, who proactively monitored, intervened in, and guided residents' decisions. Residents relied on nurses and pharmacists for nonjudgmental answers to their queries, especially after-hours. To enhance both types of supervision, residents emphasized the importance of improving interpersonal communication skills.

Conclusions: Residents depended on interprofessional supervision when making decisions regarding medications in the ICU. Improving interprofessional supervision, which thus far has been underrecognized and underemphasized in graduate medical education, can potentially improve medication safety in high-risk settings.

PubMed Disclaimer

Figures

Appendix Figure 1
Appendix Figure 1
Channels of communication in traditional and interprofessional supervision
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Fallon WF, Jr., Wears RL, Tepas JJ., III Resident supervision in the operating room: does this impact on outcome? J Trauma. 1993;35:556–560. - PubMed
    1. Gennis VM, Gennis MA. Supervision in the outpatient clinic: effects on teaching and patient care. J Gen Intern Med. 1993;8:378–380. - PubMed
    1. Institute of Medicine (IOM) Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. National Academic Press; Washington, DC: 2008. - PubMed
    1. Joint Committee of the Group on Resident Affairs and Organization of Resident Representatives . Patient safety and graduate medical education. Vol. 1. Association of American Medical Colleges; 2003. pp. 1–22.
    1. Shojania KG, Fletcher KE, Saint S. Graduate Medical Education and Patient Safety: A Busy--and Occasionally Hazardous--Intersection. Ann Intern Med. 2006;145:592–598. - PubMed

Publication types