• The instrument is planned for future studies to assess the association between resident supervision and training outcomes, clinical workload, patient outcomes, quality of care, and care costs. [ Time Frame: 1 Year ] [ Designated as safety issue: No ]
  

OBJECTIVES: To develop, assess feasibility, and test the validity of the Resident Supervision Index (RSI), a survey tool for medical residents designed to measure quantitatively the level of supervision the resident received while caring for an outpatient during a patient care encounter.

RESEARCH DESIGN: This is a prospective trial assessing the Residency Supervision Index (Index) applied to outpatient care encounters for content validity, test-retest reliability, and construct validity.

METHODOLOGY: Trained interviewers will administer the Index during face-to-face and in-clinic interviews, with consented residents (n=60) within 6 hours and again within 24 hours attending physicians (n=25) within 6 hours, and consented nurses (n=20) within 6 hours after the resident completes the care of a randomly selected outpatient care encounter (=250 clinic stops) during the data collection period (=4 months) at outpatient clinics of the Loma Linda VA Medical Center. Study encounters, or clinic stops, are selected at random during selected observation days for patients who have a primary or secondary diagnosis of major depression or diabetes.

For each encounter, data comes from administering the Resident Supervision Index to the resident, attending, and other health professional (nurse). Information about each patient encounter (procedures, diagnoses) comes from chart reviews. Procedures are coded into Current Physician Codes and weighted by VA Reasonable charges to estimate encounter costs as a proxy for case complexity. Baseline data comes from face-to-face interviews with consented resident, attending, and other professional, and includes administering the Office of Management and Budget-approved Learner's Perception Survey (residents only), and brief demographic and education survey (resident, attending, other professional) determining years experience, training background, and clinical discipline.

Test-retest reliability is assessed by re-administering the Index to residents for within 24 hours of the encounter. Content validity is assessed by convening a national expert panel (12 members) to review index elements and scoring algorithm. Feasibility is determined by measuring completion rates and total time necessary to complete the questionnaire and qualitative comments by residents. Concurrent validity is assessed by re-administering the Index to the attending and other professional (nurse) involved in the case encounter. Construct validity is assessed by examining if the supervision level is inversely related to resident experience (year of training), case complexity (presence of comorbid condition, costs of the encounter based on procedures done), and resident satisfaction. Resident satisfaction is determined by responses to the Office of Academic Affiliations Learner's Perception Survey (OMB-approved for VA residents). Analyses are designed to correct for attending-resident and resident-encounter nesting.

CLINICAL RELATIONSHIPS: The study will help our understanding of how residents at VA medical centers receive training and are supervised for the purpose of both education and patient outcomes.

IMPACT/SIGNIFICANCE: The instrument is planned for future studies to assess the association between resident supervision and training outcomes, clinical workload, patient outcomes, quality of care, and care costs.