title: Effects of clinical supervision on resident learning and patient care during simulated ICU scenarios.
abstract: OBJECTIVE
  Closer supervision of residents' clinical activities has been promoted to improve patient safety, but may additionally affect resident participation in patient care and learning. The objective of this study was to determine the effects of closer supervision on patient care, resident participation, and the development of resident ability to care independently for critically ill patients during simulated scenarios.
  
  
  METHODS
  This quantitative study represents a component of a larger mixed-methods study. Residents were randomized to one of three levels of supervision, defined by the physical proximity of the supervisor (distant, immediately available, and direct). Each resident completed a simulation scenario under the supervision of a critical care fellow, immediately followed by a modified scenario of similar content without supervision.
  
  
  METHODS
  The simulation center of a tertiary, university-affiliated academic center in a large urban city.
  
  
  METHODS
  Fifty-three residents completing a critical care rotation and 24 critical care fellows were recruited between April 2009 and June 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  During the supervised scenarios, lower team performance checklist scores were obtained for distant supervision compared with immediately available and direct supervision (mean [SD], direct: 72% [12%] vs immediately available: 77% [10%] vs distant: 61% [11%]; p = 0.0013). The percentage of checklist items completed by the residents themselves was significantly lower during direct supervision (median [interquartile range], direct: 40% [21%] vs immediately available: 58% [16%] vs distant: 55% [11%]; p = 0.005). During unsupervised scenarios, no significant differences were found on the outcome measures.
  
  
  CONCLUSIONS
  Care delivered in the presence of senior supervising physicians was more comprehensive than care delivered without access to a bedside supervisor, but was associated with lower resident participation. However, subsequent resident performance during unsupervised scenarios was not adversely affected. Direct supervision of residents leads to improved care process and does not diminish the subsequent ability of residents to function independently.
authors: 1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 2Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. 3Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada. 4Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. 5Faculty of Medicine, Centre for Health Education Scholarship, University of British Columbia, Vancouver, BC, Canada.
authors: Dominique
authors: D
authors: Piquette
authors: Jordan
authors: J
authors: Tarshis
authors: Glenn
authors: G
authors: Regehr
authors: Robert A
authors: RA
authors: Fowler
authors: Ruxandra
authors: R
authors: Pinto
authors: Vicki R
authors: VR
authors: LeBlanc
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003422:Critical Care; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007858:Learning; D008297:Male; D008348:Manikins; D011897:Random Allocation