Entrustment of the on-call senior medical resident role: implications for patient safety and collective care
Abstract Background The on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR com...
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| Format: | Article |
| Language: | English |
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BMC
2017-07-01
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| Series: | BMC Medical Education |
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| Online Access: | http://link.springer.com/article/10.1186/s12909-017-0959-3 |
| _version_ | 1818991656507015168 |
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| author | Noureen Huda Lisa Faden Mark Goldszmidt |
| author_facet | Noureen Huda Lisa Faden Mark Goldszmidt |
| author_sort | Noureen Huda |
| collection | DOAJ |
| description | Abstract Background The on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR competency prior to granting these on-call responsibilities in internal medicine. In order to fulfill competency based medical education requirements, training programs need to develop assessment approaches to make and defend such entrustment decisions. The purpose of this study is to understand the clinical activities and outcomes of the on-call SMR role and provide training programs with a rigorous model for entrustment decisions for this role. Methods This four phase study utilizes a constructivist grounded theory approach to collect and analyse the following data sets: case study, focus groups, literature synthesis of supervisory practices and return-of-findings focus groups. The study was conducted in two Academic Health Sciences Centres in Ontario, Canada. The case study included ten attending physicians, 13 SMRs, 19 first year residents and 14 medical students. The focus groups included 19 SMRs. The later, return-of-findings focus groups included ten SMRs. Results Five core on-call supervisory tasks (overseeing ongoing patient care, briefing, case review, documentation and preparing for handover) were identified, as well as a range of practices associated with these tasks. We also identified challenges that influenced the extent to which SMRs were able to effectively perform the core tasks. At times, these challenges led to omissions of the core tasks and potentially compromised patient safety and the admission transition of care. Conclusion By identifying the core supervisory tasks and associated practices, we were able to identify the competencies for the on-call SMR role. Our findings can further be used by training programs for assessment and for making entrustment decisions. |
| first_indexed | 2024-12-20T20:13:44Z |
| format | Article |
| id | doaj.art-0a47899b42774f44888ca07609d3ecce |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-12-20T20:13:44Z |
| publishDate | 2017-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-0a47899b42774f44888ca07609d3ecce2022-12-21T19:27:45ZengBMCBMC Medical Education1472-69202017-07-011711910.1186/s12909-017-0959-3Entrustment of the on-call senior medical resident role: implications for patient safety and collective careNoureen Huda0Lisa Faden1Mark Goldszmidt2Department of Medicine, Schulich School of Medicine and Dentistry, Western UniversityCentre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition, Suite 110Department of Medicine, Schulich School of Medicine and Dentistry, Western UniversityAbstract Background The on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR competency prior to granting these on-call responsibilities in internal medicine. In order to fulfill competency based medical education requirements, training programs need to develop assessment approaches to make and defend such entrustment decisions. The purpose of this study is to understand the clinical activities and outcomes of the on-call SMR role and provide training programs with a rigorous model for entrustment decisions for this role. Methods This four phase study utilizes a constructivist grounded theory approach to collect and analyse the following data sets: case study, focus groups, literature synthesis of supervisory practices and return-of-findings focus groups. The study was conducted in two Academic Health Sciences Centres in Ontario, Canada. The case study included ten attending physicians, 13 SMRs, 19 first year residents and 14 medical students. The focus groups included 19 SMRs. The later, return-of-findings focus groups included ten SMRs. Results Five core on-call supervisory tasks (overseeing ongoing patient care, briefing, case review, documentation and preparing for handover) were identified, as well as a range of practices associated with these tasks. We also identified challenges that influenced the extent to which SMRs were able to effectively perform the core tasks. At times, these challenges led to omissions of the core tasks and potentially compromised patient safety and the admission transition of care. Conclusion By identifying the core supervisory tasks and associated practices, we were able to identify the competencies for the on-call SMR role. Our findings can further be used by training programs for assessment and for making entrustment decisions.http://link.springer.com/article/10.1186/s12909-017-0959-3Entrustable professional activities (EPAs)On-call supervisionCompetency |
| spellingShingle | Noureen Huda Lisa Faden Mark Goldszmidt Entrustment of the on-call senior medical resident role: implications for patient safety and collective care BMC Medical Education Entrustable professional activities (EPAs) On-call supervision Competency |
| title | Entrustment of the on-call senior medical resident role: implications for patient safety and collective care |
| title_full | Entrustment of the on-call senior medical resident role: implications for patient safety and collective care |
| title_fullStr | Entrustment of the on-call senior medical resident role: implications for patient safety and collective care |
| title_full_unstemmed | Entrustment of the on-call senior medical resident role: implications for patient safety and collective care |
| title_short | Entrustment of the on-call senior medical resident role: implications for patient safety and collective care |
| title_sort | entrustment of the on call senior medical resident role implications for patient safety and collective care |
| topic | Entrustable professional activities (EPAs) On-call supervision Competency |
| url | http://link.springer.com/article/10.1186/s12909-017-0959-3 |
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