title: Supervising incoming first-year residents: faculty expectations versus residents' experiences.
abstract: BACKGROUND
  First-year residents begin clinical practice in settings in which attending staff and senior residents are available to supervise their work. There is an expectation that, while being supervised and as they become more experienced, residents will gradually take on more responsibilities and function independently.
  
  
  OBJECTIVE
  This study was conducted to define 'entrustable professional activities' (EPAs) and determine the extent of agreement between the level of supervision expected by clinical supervisors (CSs) and the level of supervision reported by first-year residents.
  
  
  METHODS
  Using a nominal group technique, subject matter experts (SMEs) from multiple specialties defined EPAs for incoming residents; these represented a set of activities to be performed independently by residents by the end of the first year of residency, regardless of specialty. We then surveyed CSs and first-year residents from one institution in order to compare the levels of supervision expected and received during the day and night for each EPA.
  
  
  RESULTS
  The SMEs defined 10 EPAs (e.g. completing admission orders, obtaining informed consent) that were ratified by a national panel. A total of 113 CSs and 48 residents completed the survey. Clinical supervisors had the same expectations regardless of time of day. For three EPAs (managing i.v. fluids, obtaining informed consent, obtaining advanced directives) the level of supervision reported by first-year residents was lower than that expected by CSs (p < 0.001) regardless of time of day (i.e. day or night). For four more EPAs (initiating the management of a critically ill patient, handing over the care of a patient to colleagues, writing a discharge prescription, coordinating a patient discharge) differences applied only to night-time work (p ≤ 0.001).
  
  
  CONCLUSIONS
  First-year residents reported performing EPAs with less supervision than expected by CSs, especially during the night. Using EPAs to guide the content of the undergraduate curriculum and during examinations could help better align CSs' and residents' expectations about early residency supervision.
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Medical Council of Canada, Ottawa, Ontario, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Touchie
authors.forename: André
authors.initials: A
authors.lastname: De Champlain
authors.forename: Debra
authors.initials: D
authors.lastname: Pugh
authors.forename: Steven
authors.initials: S
authors.lastname: Downing
authors.forename: Georges
authors.initials: G
authors.lastname: Bordage
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009864:Ontario; D011364:Professional Practice / Q000592:standards