The relationship between resident work hours and patient safety has been studied at length; however, research on the effect of attending physician supervision on patient safety is limited.
For a study published in JAMA Internal Medicine, Kathleen Finn, MD, Christiana Iyasere, MD, MBA, and colleagues studied the effect of increased attending physician supervision in an inpatient resident general medical service on patient safety and educational outcomes. “With the growth of the hospitalist movement, more faculty physicians join daily resident work rounds under the assumption that increased supervision is better for patient safety and resident education,” says Dr. Finn. “However, supervision is a complex balancing act of patient safety and resident education.”
The study invited 22 attendings to spend 2 weeks with increased supervision (rounding with the team on established patients) and a different 2 weeks on standard supervision (discussing established patients and examining them independently). A total of 1,259 patients (5,772 patient-days) were included in the analysis. The medical error rate was not significantly different between standard vs increased supervision. Time-motion analysis of 161 work rounds found no difference in mean length of time spent discussing established patients in the two models. Additionally, interns reported feeling less efficient and less autonomous with an attending physician present.
“There was no statistical difference in medical error rates, mortality, transfer to the intensive care unit, or length of stay between the direct supervision and usual care groups,” says Dr. Finn. “Residency programs should consider the individualized needs of their institution and residents in determining the appropriate level of supervision and not assume that more supervision is always better.”
Finn K, Metlay J, Chang Y, et al. Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education. JAMA Intern Med. 2018;178(7):952-959. Available at