title: Strategies for effective on-call supervision for internal medicine residents: the superb/safety model.
abstract: BACKGROUND
  Supervision is central to resident education and patient safety, yet there is little published evidence to describe a framework for clinical supervision. The aim of this study was to describe supervision strategies for on-call internal medicine residents.
  
  
  METHODS
  Between January and November 2006, internal medicine residents and attending physicians at a single hospital were interviewed within 1 week of their final call on the general medicine rotation. Appreciative inquiry and critical incident technique were used to elicit perspectives on ideal and suboptimal supervision practices. A representative portion of transcripts were analyzed using an inductive approach to develop a coding scheme that was then applied to the entire set of transcripts. All discrepancies were resolved via discussion until consensus was achieved.
  
  
  RESULTS
  Forty-four of 50 (88%) attending physicians and 46 of 50 (92%) eligible residents completed an interview. Qualitative analysis revealed a bidirectional model of suggested supervisory strategies, the "SUPERB/SAFETY" model; an interrater reliability of 0.70 was achieved. Suggestions for attending physicians providing supervision included setting expectations, recognizing uncertainty, planning communication, having easy availability, reassuring residents, balancing supervision, and having autonomy. Suggested resident strategies for seeking supervision from attending physicians included seeking input early, contacting for active clinical decisions or feeling uncertain, end of life issues, transitions in care, or help with systems issues. Common themes suggested by trainees and attending physicians included easy availability and preservation of resident decision-making autonomy.
  
  
  CONCLUSIONS
  Residents and attending physicians have explicit expectations for optimal supervision. The SUPERB/SAFETY model of supervision may be an effective resource to enhance the clinical supervision of residents.
authors: Jeanne M
authors: JM
authors: Farnan
authors: Julie K
authors: JK
authors: Johnson
authors: David O
authors: DO
authors: Meltzer
authors: Ilene
authors: I
authors: Harris
authors: Holly J
authors: HJ
authors: Humphrey
authors: Alan
authors: A
authors: Schwartz
authors: Vineet M
authors: VM
authors: Arora