Tuesday, April 13, 2010

Watch Me!

In the March issue of the Journal of Graduate Medical Education there is a paper entitled "How Residents View Their Clinical Supervision: A Reanalysis of Classic National Survey Data". This paper presents the results of a 1999 survey of 3,604 PGY 2 and PGY 3 residents. (The "PGY" refers to "post-graduate year", in other words how far along the physician is in her training after medical school.) The residents in this survey represented a random sample of 14% percent of all physicians in training, and almost two-thirds of the residents responded to the survey.

The good news is that the majority of the residents felt they had adequate supervision during their training.

Unfortunately, about a quarter of the residents reported that they had seen patients without adequate supervision at least once a week. Five percent said this occurred almost daily. Residents in opththalmology, neurology, neurosurgery and psychiatry were more likely to report inadequate supervision, while residents in pathology and dermatology were least likely to experience this.

Poorly supervised residents reported many other problems with their training programs, all of which could affect patient safety. Residents without adequate supervision also reported increased use of alcohol, significant weight change, or use of medications either to stay awake, to help them sleep, or to help them cope with the residency. They were also more likely to report higher ratings of self-assessed stress, sleep deprivation, total weekly work hours, and having worked while in an impaired condition. They were also more likely to report that they personally had been belittled and humiliated, or physically assaulted while working. In spite of all this, there was no correlation between sleep-related medical errors and being named in a malpractice suit.

Recently the Institute of Medicine issued a report with recommendations to reform graduate medical education. The report emphasized the connection between a healthy working (or training) environment and safe patient care. Surprisingly, medical organizations have not widely welcomed this. Certain specialty organizations are concerned that duty hour reform may deprive residents of valuable training experience and that the financial burden of duty hour reform will drive up the cost of health care. What this survey highlights is the fact that failure to adequately supervise residents and to provide humane working conditions creates a risk for the young physician as well as the patient.