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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.
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 test-retest reliability and construct validity.
METHODOLOGY: Trained interviewers administered the Index during face-to-face and in-clinic interviews with 60 consenting resident physicians and their 37 consenting attending physicians to descsribe the care they provided to 143 patients at the outpatient clinics involving 148 clinical encounters at the Loma Linda VA Medical Center.
For each encounter, data comes from administering the Resident Supervision Index to the resident and attending. Baseline data describing each subject (attending physicians and resident physicians) came from face-to-face interviews.
Test-retest reliability is assessed by re-administering the Index to residents for within 24 hours of the encounter. Concurrent validity is assessed by re-administering the Index to the attending physician responsible for the patient's care.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Residents and Attending Physicians | This group contains the residents and the attending physicians who consented to participate in the study. They participated in a survey administered by a research assistant. Both physician resident and attending physicians were administered the survey twice within 24-hours and their test-retest responses were compared for reliability. Responses to attending and resident physicians covering the care for the patient and clinical care encounter were compared for accuracy. |
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| Measure | Description | Time Frame |
|---|---|---|
| Intraclass Correlation Coefficient Between Physician Resident and Attending Physician. | Describes agreement between physician resident and attending physician assessment of total resident supervision time for a given patient and patient care clinical encounter. | 24-hours |
| Measure | Description | Time Frame |
|---|---|---|
| Intraclass Correlation Coefficient Assessing Test-retest Reliability for Resident Physicians | Assesses the test-retest reliability of repeated responses for resident physicians only to report the total time spent during resident supervision. | 24 hours |
| Intraclass Correlation Coefficient for Test-retest Reliability for Attending Physicians |
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Inclusion Criteria:
Exclusion Criteria:
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Residents
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| Name | Affiliation | Role |
|---|---|---|
| Terrell Michael Kashner, PhD JD MPH | VA Loma Linda Healthcare System, Loma Linda, CA | Principal Investigator |
| Dale S. Cannon, PhD | VA Salt Lake City Health Care System, Salt Lake City, UT | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Loma Linda Healthcare System, Loma Linda, CA | Loma Linda | California | 92357 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 18520472 | Background | Cannon GW, Keitz SA, Holland GJ, Chang BK, Byrne JM, Tomolo A, Aron DC, Wicker AB, Kashner TM. Factors determining medical students' and residents' satisfaction during VA-based training: findings from the VA Learners' Perceptions Survey. Acad Med. 2008 Jun;83(6):611-20. doi: 10.1097/ACM.0b013e3181722e97. | |
| 20592508 | Background |
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| ID | Title | Description |
|---|---|---|
| FG000 | Group 1 | The study began with 112 responders: 75 physician residents and 37 attending physicians. Only 60 of the 75 residents had been supervised by one of the 37 participating attending physicians. Thus, 15 residents were dropped from study. Both resident and their attending physician were surveyed to report total supervision time for each of 148 clinical encounters with 143 patients. There were more clinical encounters than patients because some patients had more than one encounter. There were more physician residents than attending physicians because attending physicians may have supervised more than one resident. There were more clinical encounters than residents because a resident may be involved in more than one clinical encounter with a patient. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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Physician residents who consented to participate in the study.
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| ID | Title | Description |
|---|---|---|
| BG000 | Physician Residents and Attending Physicians | includes physician residents and attending physicians who were asked to sit through a face to face interview with a research assistant following a clinical encounter with a patient |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Intraclass Correlation Coefficient Between Physician Resident and Attending Physician. | Describes agreement between physician resident and attending physician assessment of total resident supervision time for a given patient and patient care clinical encounter. | Posted | Number | 95% Confidence Interval | Intraclass Correlation Coefficient | 24-hours |
|
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Collected during the 3-months when subjects were interviewed only.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group 1 | Sample included 75 resident physicians. No adverse events noted. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| quality of care | General disorders | Non-systematic Assessment | There were no adverse health events. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| dissatisfaction with education experience | General disorders | Non-systematic Assessment | Reflects dissatisfaction with education experience |
Single site study limiting generalizability of findings
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| T. Michael Kashner, PhD, PI | Loma Linda VA Healthcare System | 909 825-7084 | 2853 | michael.kashner@va.gov |
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The study did not involve a biospecimen. None was collected. None was retained.
Assesses the test-retest reliability among repeated responses to surveys administered to attending physicians only. |
| 24 hours |
| Kashner TM, Henley SS, Golden RM, Byrne JM, Keitz SA, Cannon GW, Chang BK, Holland GJ, Aron DC, Muchmore EA, Wicker A, White H. Studying the effects of ACGME duty hours limits on resident satisfaction: results from VA learners' perceptions survey. Acad Med. 2010 Jul;85(7):1130-9. doi: 10.1097/ACM.0b013e3181e1d7e3. |
| 20305532 | Result | Byrne JM, Kashner M, Gilman SC, Aron DC, Cannon GW, Chang BK, Godleski L, Golden RM, Henley SS, Holland GJ, Kaminetzky CP, Keitz SA, Kirsh S, Muchmore EA, Wicker AB. Measuring the intensity of resident supervision in the department of veterans affairs: the resident supervision index. Acad Med. 2010 Jul;85(7):1171-81. doi: 10.1097/ACM.0b013e3181d5a954. |
| 21975879 | Result | Kashner TM, Byrne JM, Henley SS, Golden RM, Aron DC, Cannon GW, Chang BK, Gilman SC, Holland GJ, Kaminetzky CP, Keitz SA, Muchmore EA, Kashner TK, Wicker AB. Measuring progressive independence with the resident supervision index: theoretical approach. J Grad Med Educ. 2010 Mar;2(1):8-16. doi: 10.4300/JGME-D-09-00083.1. |
| 21975880 | Result | Kashner TM, Byrne JM, Chang BK, Henley SS, Golden RM, Aron DC, Cannon GW, Gilman SC, Holland GJ, Kaminetzky CP, Keitz SA, Muchmore EA, Kashner TK, Wicker AB. Measuring progressive independence with the resident supervision index: empirical approach. J Grad Med Educ. 2010 Mar;2(1):17-30. doi: 10.4300/1949-8357-2.1.17. |
| Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Secondary | Intraclass Correlation Coefficient Assessing Test-retest Reliability for Resident Physicians | Assesses the test-retest reliability of repeated responses for resident physicians only to report the total time spent during resident supervision. | Posted | Number | 95% Confidence Interval | Intraclass Correlation Coefficient | 24 hours |
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| Secondary | Intraclass Correlation Coefficient for Test-retest Reliability for Attending Physicians | Assesses the test-retest reliability among repeated responses to surveys administered to attending physicians only. | Posted | Number | 95% Confidence Interval | Intraclass Correlation Coefficient | 24 hours |
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| 0 |
| 75 |
| 0 |
| 75 |
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| Mental breakdown | Psychiatric disorders | Non-systematic Assessment | Potential for mental breakdown due to stress of completing a survey in clinic |
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| Eye strain | Eye disorders | Non-systematic Assessment | Eye strain attempting to complete a survey |
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