title: Written Comments Made by Anesthesia Residents When Providing Below Average Scores for the Supervision Provided by the Faculty Anesthesiologist.
abstract: Anesthesia residents in our department evaluate the supervision provided by the faculty anesthesiologist with whom they worked the previous day. What advice managers can best provide to the faculty who receive below-average supervision scores is unknown.
  
  
  
  The residents provided numerical answers (1 "never," 2 "rarely," 3 "frequently," or 4 "always") to each of the 9 supervision questions, resulting in a total supervision score. A written comment could also be provided.
  
  
  
  Over 2.5 years, the response rate to requests for evaluation was 99.1%. There were 13,664 evaluations of 76 faculty including 1387 comments. There were 25 evaluations with a comment of disrespectful behavior. For all 25, the question evaluating whether "the faculty treated me respectfully" was answered <4 (i.e., not "always"). The supervision scores were less than for the other evaluations with comments (P < 0.0001). Each increase in the faculty's number of comments of being disrespectful was associated with a lesser mean score (P = 0.0002). A low supervision score (<3.00; i.e., less than "frequent") had an odds ratio of 85 for disrespectful faculty behavior (P < 0.0001). The predictive value of the supervision score not being low for absence of a comment of disrespectful behavior was 99%. That finding was especially useful because 94% of scores below average (<3.80) were not low (≥3.00). There were 6 evaluations with a comment of insufficient faculty presence. Those evaluations had lesser scores than the other evaluations with comments (P < 0.0001). The 6 faculty with 1 such comment had lesser mean scores than the other faculty (P = 0.0071). There were 34 evaluations with a comment about poor-quality teaching. The evaluations related to poor teaching had lesser scores than the other evaluations with comments (P < 0.0001). The faculty who each received such a comment had lesser mean scores than the other faculty (P < 0.0001). Each increase in the faculty's number of comments of poor-quality teaching was associated with a lesser mean score (P = 0.0002). The 9 supervision questions were internally consistent (Cronbach α = 0.948). A faculty with a comment about poor-quality teaching had significant odds of also having a comment about insufficient presence (P = 0.0044). A comment with negative sentiment had significant odds of being about poor-quality teaching rather than being about insufficient presence (odds ratio, 6.00; P < 0.0001).
  
  
  
  A faculty who has insufficient presence cannot be providing good teaching. Furthermore, there was negligible correlation between supervision scores and faculty clinical assignments. Thus, insufficient faculty presence accounted for a small proportion of below-average supervision scores and low-quality supervision. Furthermore, scores ≥3 have a predictive value for the absence of disrespectful behavior ≅99%. Approximately 94% of the faculty supervision scores that were below average were still ≥3. Consequently, for the vast majority of the faculty-resident-days, quality of teaching distinguished between below- versus above-average supervision scores. This result is consistent with our prior finding of a strong correlation between 6-month supervision scores and assessments of teaching effectiveness. Taken together, when individual faculty anesthesiologists are counseled about their clinical supervision scores, the attribute to emphasize is quality of clinical teaching.
authors.affiliation: From the *Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; †Department of Anesthesia, University of Iowa, Iowa City, Iowa; and ‡Active Aging Center, State University of New York at Oswego, Oswego, New York.
authors.forename: Franklin
authors.initials: F
authors.lastname: Dexter
authors.forename: Debra
authors.initials: D
authors.lastname: Szeluga
authors.forename: Danielle
authors.initials: D
authors.lastname: Masursky
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hindman
mesh_terms: D000761:Anesthesia Department, Hospital; D000072080:Anesthesiologists / Q000193:education* / Q000458:organization & administration / Q000523:psychology; D000776:Anesthesiology / Q000193:education* / Q000458:organization & administration; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods* / Q000458:organization & administration; D005180:Faculty, Medical / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency; D007398:Interpersonal Relations; D016017:Odds Ratio; D009934:Organization and Administration; D011795:Surveys and Questionnaires; D013663:Teaching / Q000458:organization & administration; D014956:Writing