Ask the expert: How can attending physicians provide better supervision for residents?

Residency Program Insider, July 13, 2010

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The following tips will help faculty members provide better supervision and eliminate many of the barriers residents face when asking for help:
Set clear expectations up front. Outline in what specific circumstances you want the resident to notify you about a patient’s condition, such as when an end-of-life decision arises or when a patient suffers an adverse event, dies, or goes to the ICU.
Make time to talk. Establish a time every night when the resident will call you, such as 10 p.m. Recognize that residents get busy and may forget to call. If that is the case, attending physicians should take responsibility and page the residents.
Be available. Attending physicians should answer all calls while on service. Some attending physicians may think that not responding or not providing residents guidance when asked promotes trainees’ autonomy, but that’s often not the case. Instead, absentee attendings often cause residents to feel abandoned.
Address uncertainty. Faculty members should assure residents, especially junior trainees, that uncertainty is part of education and that they should not feel bad about asking for help. Residents oftentimes receive little training on how to manage uncertainty, so being explicit about what to do in these situations can facilitate appropriate supervision. Tell residents that it is normal for them to feel uncertain at times and that they should not hesitate to call with questions.
Make discussions worthwhile. Conversations should be a back-and-forth dialogue between the resident and attending physician. Because few attending physicians have formal training in being a supervisor, they may tend to overmanage and not cultivate the resident’s clinical decision-making skills. When attending physicians run through the list of patients and dictate what the resident should do, residents don’t learn. Instead, ask what the resident wants to do or why he or she did something a certain way. Having a real discussion helps balance the need for appropriate supervision with the residents’ autonomy. 

This week’s question and answer are from the July 2010 issue of Residency Program Alert.

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