Supervision Models in Training Environments

Study Overview
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Brief Summary
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Attending physicians often supervise novice junior residents in a direct one-to-one format. Alternatively, a senior resident can be paired with a new trainee under the non-direct (but immediately available) supervision of an attending physician. Resident supervision has been considered an important step towards independent practice. Both models are ubiquitous in the United States, but no study to date has been performed if one model is better than the other with respect to supervision scores.

Detailed Description
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Supervision of residents is a cornerstone of ACGME accreditation and a critical focus of any training program. A nine-faceted, validated survey has been used to assess quality and effectiveness of supervision in training environments. Residents that assign poor scores for faculty members also tend to poorly evaluate the department-at-large. Further, residents that evaluate supervisors unfavorably also tend to report more patient safety mishaps in the context of a less safe work environment. Previous literature that used this supervision scale concluded that residents who reported mean department-wide supervision scores less than 3 (frequent) reported significantly more frequent occurrences of mistakes with negative consequences to patients and medication errors. Attending physicians often supervise novice junior residents in a direct one-to-one format. Alternatively, a senior resident can be paired with a new trainee under the non-direct (but immediately available) supervision of an attending physician. Resident supervision has been considered an important step towards independent practice.. Both models are ubiquitous in the United States, but no study to date has been performed if one model is better than the other with respect to supervision scores.

Official Title
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Assessing the Quality and Effectiveness of Two Common Supervision Models in Training Environments Using a Validated Supervision Instrument

Conditions
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Supervision, Anesthesia

Intervention / Treatment
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* Behavioral: Survey


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: New incoming anesthesia residents assigned to healthy patients (ASA physical status classifications of 1 or 2). Exclusion Criteria: New incoming anesthesia residents assigned to patients with ASA physical status classifications 3 or greater.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Attending physician for direct 1:1 supervision<br>Participants will be assigned to an attending physician for direct 1:1 supervision. The participants will fill out a survey at the end of the day for 16 consecutive days. | Behavioral: Survey<br>* A survey will be completed by the participants at the conclusion of each day.<br>|
| Experimental: Senior resident for direct 1:1 supervision<br>Participants will be assigned to an senior resident as a direct supervisor with oversight from an attending physician (in accordance with CMS/ACGME staffing criteria). The participants will fill out a survey at the end of the day for 16 consecutive days. | Behavioral: Survey<br>* A survey will be completed by the participants at the conclusion of each day.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Supervision evaluation questionnaire | A series of questions pertaining to planning perianesthesia care, feedback, availability, opportunities, stimulating patient based learning, professionalism, interpersonal skills, presence, and safety. It questions are scored using a 4-point Likert scale (never = 1, rarely = 2, frequently = 3, and always = 4). A score less than 3 is associated with more frequent occurrences of mistakes. | At the conclusion of each day for 16 consecutive days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Spielberger State-Trait Anxiety Inventory Short Form | (Strongly agree=5, Agree=4, Neither=3, Disagree=2, Strongly Disagree=1). | At the conclusion of each day for 16 consecutive days |