title: Direct Supervision in Outpatient Psychiatric Graduate Medical Education.
abstract: OBJECTIVE
  The authors describe a stimulus case that led training staff to examine and revise the supervision policy of the adult and child and adolescent psychiatry clinics. To inform the revisions, the authors reviewed the literature and national policies.
  
  
  METHODS
  The authors conducted a literature review in PubMed using the following criteria: Supervision, Residents, Training, Direct, and Indirect and a supplemental review in Academic Psychiatry. The authors reviewed institutional and Accreditation Council for Graduate Medical Education resident and fellow supervision policies to develop an outpatient and fellow supervision policy.
  
  
  RESULTS
  Research is limited in psychiatry with three experimental articles demonstrating positive impact of direct supervision and several suggesting different techniques for direct supervision. In other areas of medicine, direct supervision is associated with improved educational and patient outcomes. The authors present details of our new supervision policy including triggers for direct supervision.
  
  
  CONCLUSIONS
  The term direct supervision is relatively new in psychiatry and medical education. There is little published on the extent of implementation of direct supervision and on its impact on the educational experience of psychiatry trainees and other medical specialties. Direct supervision has been associated with improved educational and patient outcomes in nonpsychiatric fields of medicine. More research is needed on the implementation of, indications for, and effects of direct supervision on trainee education and on patient outcomes.
authors.affiliation: State University of New York (SUNY) Downstate and Kings County Hospital Center, Brooklyn, NY, USA. cathryn.galanter@downstate.edu.
authors.forename: Cathryn A
authors.initials: CA
authors.lastname: Galanter
authors.affiliation: State University of New York (SUNY) Downstate and Kings County Hospital Center, Brooklyn, NY, USA.
authors.forename: Roumen
authors.initials: R
authors.lastname: Nikolov
authors.affiliation: State University of New York (SUNY) Downstate and Kings County Hospital Center, Brooklyn, NY, USA.
authors.forename: Norma
authors.initials: N
authors.lastname: Green
authors.affiliation: Hofstra North Shore-LIJ School of Medicine, Glen Oaks, NY, USA.
authors.forename: Shivana
authors.initials: S
authors.lastname: Naidoo
authors.affiliation: State University of New York (SUNY) Downstate and Kings County Hospital Center, Brooklyn, NY, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Myers
authors.affiliation: State University of New York (SUNY) Downstate and Kings County Hospital Center, Brooklyn, NY, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Merlino
mesh_terms: D000068:Accreditation; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002648:Child; D002665:Child Psychiatry / Q000193:education; D004503:Education, Medical, Graduate / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008611:Mentors; D011570:Psychiatry / Q000193:education*
keywords: Adolescent psychiatry fellowship; Direct; Indirect; Psychiatry; Residency-Child; Supervision; Training