Does increased supervision of resident physicians reduce medical errors?

Bottom Line: Increased supervision of residents by attending physicians who joined patient rounds didn't significantly reduce medical errors but residents reported decreased autonomy.

Why The Research Is Interesting: The relationship between resident work hours and patient safety has been studied extensively but less is known about the role of attending physician supervision on patient safety.

Who and When: 22 attending physicians participated in this randomized clinical trial performed on an inpatient general medical service at a large academic center with 188 internal medicine residents from September 2015 to June 2016

What (Study Interventions and Outcomes): Increased direct supervision where attending physicians joined patient work rounds on previously admitted patients or standard supervision when attending physicians were available for rounds but didn't join (interventions); rate of medical errors (measures)

How (Study Design): This was a randomized clinical trial (RCT). RCTs allow the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those that were studied in the RCT.

Authors: Kathleen M. Finn, M.D., Massachusetts General Hospital, Boston, and coauthors

Results: In this randomized clinical trial of 22 attending physicians each providing 2 different levels of supervision, increased supervision did not significantly reduce the rate of medical errors but did result in interns speaking less and residents reporting a decreased level of autonomy.

Study Limitations: Conducted at a single medical center with a large academic residency program

Study Conclusions: Residency training programs should reconsider the appropriate level of attending physician supervision when designing rounds to balance patient safety, excellent care, the needs of residents who are there to learn, and resident autonomy.

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Related material: The commentary, "Optimizing the Balance Between Supervision and Autonomy in Training," by Brian E. Neubauer, M.D., of Walter Reed National Military Medical Center, Bethesda, and coauthors is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.1244)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.