title: Discrepancies in After-Hours Communication Attitudes between Pediatric Residents and Supervising Physicians.
abstract: OBJECTIVE
  To examine differences in expectations when a resident should contact a supervising physician in several hospital-based, after-hours clinical circumstances.
  
  
  METHODS
  We developed 34 scenarios collectively considered the most common or serious issues encountered by on-call residents, and incorporated them into a survey of pediatric residents, fellows, and attendings. For each scenario, participants were asked whether the resident should talk to the attending/fellow immediately or delay communication until the next day. ORs comparing attendings/fellows and residents were calculated, and subgroup analyses were performed examining differences among the study populations.
  
  
  RESULTS
  A total of 112 participants completed the survey (91% response rate). In 17 of the 34 scenarios (50%), more attendings/fellows than residents asked for immediate communication (OR >1; P < .05). Most discrepant scenarios were in uncertain areas in which residents may feel comfortable managing the issue without supervisory input or, alternatively, fail to recognize an evolving matter or a deteriorating clinical status. In subgroup analyses, residents were homogeneous in their responses; however, responses of fellows and junior faculty differed from those of senior faculty in 7 of the 34 scenarios, with senior attendings more likely desiring immediate communication.
  
  
  CONCLUSIONS
  We found differences in expectations of when a pediatric resident should contact a supervising physician after hours not only between residents and attendings/fellows, but among attendings themselves. These differences could lead to medical errors, miscommunication, and inconsistent supervision for overnight residents.
authors.affiliation: Pediatric Medical Services, Harvard Medical School, Boston, MA. Electronic address: PalakshappaD@email.chop.edu.
authors.forename: Deepak
authors.initials: D
authors.lastname: Palakshappa
authors.affiliation: Pediatric Medical Services, Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Carter
authors.affiliation: Pediatric Medical Services, Harvard Medical School, Boston, MA; Division of Pediatric Hospital Medicine, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA; Division of Pediatric Infectious Diseases, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA.
authors.forename: Chadi M
authors.initials: CM
authors.lastname: El Saleeby
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D003142:Communication; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education*; D010820:Physicians / Q000523:psychology*; D014481:United States