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BACKGROUND/RATIONALE:
VA spends $1b annually to provide clinical rotations for a total 25-30% of all residents in ACGME approved US graduate medical education training programs. Though education is one of VAs four missions, few studies have attempted to assess the cost to VA to maintain these programs, or its impact on patient outcomes, quality of care, resident education, or contribution to clinical productivity in treating veterans. A critical issue in all such studies is assessing the level of supervision that residents receive while rotating through VA facilities. While ordinal measures for procedural care (surgery) are available, there are no scientifically validated measures to assess supervision of residents in outpatient care.
OBJECTIVE(S):
Objective: This study will further refine and test the Resident Supervision Index designed to measure the level of supervision a resident receives during a patient care encounter at VA non-procedural (non-surgery) outpatient care clinics.
METHODS:
Methods: The RSI will be evaluated for content validity using an Expert Panel. Refinements will be incorporated (as a minor protocol change) before applying the measure at the Loma Linda VAMC Outpatient care clinics. Feasibility will be assessed by administering the index in face-to-face interviews to physician residents at the end of their shift (primary measure), and at the beginning of their next shift (test-retest) and to the attending and a nurse (concurrent reliability) for outpatients with a primary diagnosis of depression (n=30) or diabetes (n=70). Sample size reflects resident involvement. Construct validity is assessed by hypotheses testing. That is, we test if the adjusted supervision levels: (1) vary inversely by resident experience (months in training), (2) vary directly by case complexity (presence of substance abuse, psychotic features, multiple chronic conditions, symptom duration), and (3) drive resident satisfaction with VA as learning and clinical environments.
FINDINGS/RESULTS:
No results are available at this time.
IMPACT:
The Resident Supervision Index will be a critical outcome and control variable for studies these investigators have planned to assess the impact of graduate medical education on patient outcomes, quality of care, trainee education outcomes, satisfaction with VA medical centers as learning environments, and costs of both education and resident-provided health care. The index will have immediate benefits to other VA researchers, as these investigators will share results and conclusions. The index will also help advance policy by providing VA policy makers and educators insight into graduate medical education and the role it plays in caring for veterans at VA medical centers.
PUBLICATIONS:
None at this time.
DRA:
none
DRE:
none
Keywords:
none
MeSH Terms:
none
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