Perceptions of 24/7 in-hospital intensivist coverage on pediatric housestaff education

Pediatrics. 2014 Jan;133(1):88-95. doi: 10.1542/peds.2013-1990. Epub 2013 Dec 9.

Abstract

Background: In recent years, the focus on patient safety and housestaff supervision has led to a steady increase in institutions providing 24/7 in-hospital (also known as in-house, henceforth referred to as IH) coverage by pediatric intensivists. Effects of this increased attending physician presence on education of pediatric housestaff have not been studied. We hypothesized that IH coverage would decrease perceived autonomy of housestaff and negatively affect their preparedness to be independent attending physicians on completion of training.

Methods: A secure, anonymous, Web-based survey was sent to pediatric intensivists in the United States and Canada, and pediatric critical care fellows and pediatric residents at academic centers across the United States. Questions focused on perceptions of IH coverage and housestaff educational experience.

Results: We report 1323 responses from 147 institutions (center response rate 74%). Although 96% of respondents stated that the PICU provides "a good educational experience," only 50% of pediatric intensivists and 67% of housestaff feel that housestaff are prepared for independent practice after training in an IH model. Compared with those training in home-call models, respondents currently working in IH models have more favorable perceptions of the effects of IH coverage on housestaff autonomy (P < .0001), supervision (P < .0001), and preparation for independent practice (P < .0001).

Conclusions: Pediatric intensivists and housestaff express concern regarding the preparation of housestaff training in a 24/7 IH attending model. An important priority for institutions using or considering a 24/7 IH attending coverage model is the balance between adequate housestaff supervision and autonomy.

Keywords: after hours care; graduate medical education; in-house; patient safety; pediatrics; personnel staffing; professional autonomy; supervision.

MeSH terms

  • Academic Medical Centers / organization & administration*
  • Attitude of Health Personnel*
  • Canada
  • Fellowships and Scholarships
  • Health Care Surveys
  • Humans
  • Intensive Care Units, Pediatric / organization & administration*
  • Internship and Residency / organization & administration*
  • Job Satisfaction
  • Pediatrics / education*
  • Pediatrics / organization & administration
  • Professional Autonomy*
  • Surveys and Questionnaires
  • United States