Finn KM, et al. - A randomized clinical trial was performed to determine the impact of increased attending physician supervision on an inpatient resident general medical service on patient safety and educational outcomes. Researchers reported that increased direct attending physician supervision did not significantly decrease the medical error rate. Findings suggested that residency programs should reconsider their balance of patient safety, learning needs, and resident autonomy in designing morning work rounds.

Methods

• This 9-month randomized clinical trial conducted on an inpatient general medical service of a large academic medical center utilized a crossover design.
• Study participants were clinical teaching attending physicians and residents in an internal medicine residency program.
• Twenty-two faculty gave either
  • Increased direct supervision in which attending physicians joined work rounds on previously admitted patients or
  • Standard supervision in which attending physicians were available but did not join work rounds.
• Each faculty member partook in both arms in random order.
• Rate of medical errors was the primary safety outcome.
• Resident education was assessed via a time-motion study to evaluate resident participation on rounds and via surveys to measure resident and attending physician educational ratings.

Results

• According to the findings obtained, of the 22 attending physicians, 8 (36%) were women, with 15 (68%) having more than 5 years of experience.
• An aggregate of 1259 patients (5772 patient-days) were involved in the analysis.
• It was observed that the medical error rate was not significantly different between standard vs increased supervision (107.6; 95% CI, 85.8-133.7 vs 91.1; 95% CI, 76.9-104.0 per 1000 patient-days; P=.21).
• Findings revealed that time-motion analysis of 161 work rounds found no difference in mean length of time spent discussing established patients in the 2 models (202; 95% CI, 192-212 vs 202; 95% CI, 189-215 minutes; P=.99).
• It was noted that interns spoke less when an attending physician joined rounds (64; 95% CI, 60-68 vs 55; 95% CI, 49-60 minutes; P=.008).
• Interns reported feeling less efficient (41 [55%] vs 68 [73%]; P=.02) and less autonomous (53 [72%] vs 86 [91%]; P=.001) with an attending physician present and residents felt less autonomous (11 [58%] vs 30 [97%]; P < .001) in surveys.
• The outcomes showed that attending physicians rated the quality of care higher when they participated on work rounds (20 [100%] vs 16 [80%]; P=.04).