Physician supervision of residents doesn't reduce medical errors

It stands to reason oversight from an experienced colleague could help reduce mistakes from greener individuals. But increased supervision of medical residents by attending physicians during patient rounds did not significantly reduce the number of medical errors, according to a study published June 4 in JAMA Internal Medicine.

Reducing the number of medical errors ensures patient safety—but while the correlation between resident work hours and patient safety has been studied, the team from Massachusetts General Hospital in Boston examined the impact of physician supervision on patient safety. In this study, researchers examined the impact increased monitoring by attending physicians could have on patient safety.

“The growth of the hospitalist movement has increased faculty presence on the inpatient wards and, in turn, has increased direct supervision on patient rounds,” wrote first author Kathleen M. Finn, MD, and colleagues. “On some services, attending physicians commonly join both new patient rounds and work rounds on previously admitted patients, which used to be the domain of residents alone. However, it is unclear what effect this increased direct clinical supervision on work rounds has on patient safety and to what extent it affects progressive trainee independence.”

 

The nine-month study included 22 attending physicians who provided either increased direct supervision on work rounds or standard supervision not done on work rounds. A total of 1,259 patients, or 5,772 patient-days, were included in the analysis. Results showed no significant difference between standard and increased supervision. Additionally, residents spoke less and felt less efficient when physicians supervised rounds.

Increased direct attending physician supervision did not significantly reduce the medical error rate,” concluded Finn and colleagues. “Given the importance of graduated autonomy to adult learning and the value of peer learning, the decisions about level of supervision should consider the need for distance between teacher and student for learning to occur. The results of this study suggest that residency training programs reconsider the appropriate level of attending physician supervision in designing their morning rounds, balancing patient safety, excellent care, learner needs and resident autonomy.”