Supervision Models in Training Environments (VSI)

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

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.

Study Overview

• Status: Completed
• Conditions: Anesthesia; Supervision
• Intervention / Treatment: Behavioral: Survey

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Rhode Island
    • Providence, Rhode Island, United States, 02903
      • Rhode Island Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Attending physician for direct 1:1 supervision; 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; A survey will be completed by the participants at the conclusion of each day.
EXPERIMENTAL: Senior resident for direct 1:1 supervision; 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; A survey will be completed by the participants at the conclusion of each day.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Rhode Island Hospital
• Investigators: Principal Investigator: Christopher Malgieri, MD, Rhode Island Hospital

Publications and helpful links

General Publications

• De Oliveira GS Jr, Rahmani R, Fitzgerald PC, Chang R, McCarthy RJ. The association between frequency of self-reported medical errors and anesthesia trainee supervision: a survey of United States anesthesiology residents-in-training. Anesth Analg. 2013 Apr;116(4):892-7. doi: 10.1213/ANE.0b013e318277dd65. Epub 2013 Feb 5.
• De Oliveira GS Jr, Dexter F, Bialek JM, McCarthy RJ. Reliability and validity of assessing subspecialty level of faculty anesthesiologists' supervision of anesthesiology residents. Anesth Analg. 2015 Jan;120(1):209-213. doi: 10.1213/ANE.0000000000000453.
• Riveros Perez E, Jimenez E, Yang N, Rocuts A. Evaluation of Anesthesiology Residents' Supervision Skills: A Tool to Assess Transition Towards Independent Practice. Cureus. 2019 Feb 26;11(2):e4137. doi: 10.7759/cureus.4137.
• de Oliveira Filho GR, Dal Mago AJ, Garcia JH, Goldschmidt R. An instrument designed for faculty supervision evaluation by anesthesia residents and its psychometric properties. Anesth Analg. 2008 Oct;107(4):1316-22. doi: 10.1213/ane.0b013e318182fbdd.

Study record dates

Study Major Dates

• Study Start (ACTUAL): July 7, 2021
• Primary Completion (ACTUAL): July 30, 2022
• Study Completion (ACTUAL): July 30, 2022

Study Registration Dates

• First Submitted: September 29, 2021
• First Submitted That Met QC Criteria: September 29, 2021
• First Posted (ACTUAL): October 12, 2021

Study Record Updates

• Last Update Posted (ACTUAL): February 8, 2023
• Last Update Submitted That Met QC Criteria: February 6, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: 1734757

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No