Clinical oversight: Conceptualizing the relationship between supervision and safety
Clinical oversight: Conceptualizing the relationship between supervision and safety
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DOI：
10.1007/s11606-007-0179-3
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发表时间：
2007-08-01
影响因子：
5.7
通讯作者：
Regehr, Glenn
中科院分区：
文献类型：
--
作者：
Kennedy, Tara J. T.;Lingard, Lorelei;Regehr, Glenn
背景资料：对临床监督与安全、优质保健之间联系的关注导致对实习医生的监督普遍增加。增加对病人护理和实习生教育的监督的效果尚不清楚，主要是因为目前临床监督的多因素和操作性差的概念限制了评价的潜力。目的：建立一个临床监督的概念模型，以告知和指导政策和研究。设计、设置和参与者：观察实地工作和采访进行了急诊科和普通内科住院教学病房的两个学术健康科学中心与城市加拿大医学院。在常规临床活动（216小时）期间观察了12个内科和急诊医学教学团队（n=88）的成员。65名参与者（12名医生，28名居民，17名医学生，8名护士）也完成了关于监督的采访。现场笔记和采访成绩单进行了分析，紧急主题使用扎根理论methods.Results：术语“临床监督”的开发，以描述病人的护理活动进行主管，以确保护理质量。“例行监督”（对受训者临床工作的预先计划的监督）可能会使主管担心引发“反应性监督”（对受训者临床工作的双重检查或详细说明）。主管有时会进行“后台监督”（受训者并不直接意识到的监督）。当主管遇到的情况，超出了受训者的能力，他们超越临床监督，以“直接病人护理”。结论：本研究阐述了一种类型的临床监督活动，包括常规，响应，和后台监督。这种新的类型学为临床监督政策和研究提供了一个框架，以评估监督和安全之间的关系。
Background: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.Objective: To develop a conceptual model of clinical supervision to inform and guide policy and research.Design, Setting, and Participant: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with an urban Canadian medical school. Members of 12 Internal Medicine and Emergency Medicine teaching teams (n=88) were observed during regular clinical activities (216 hours). Sixty-five participants (12 physicians, 28 residents, 17 medical students, 8 nurses) also completed interviews about supervision. Field notes and interview transcripts were analyzed for emergent themes using grounded theory methodology.Results: The term "clinical oversight" was developed to describe patient care activities performed by supervisors to ensure quality of care. "Routine oversight" (preplanned monitoring of trainees' clinical work) can expose supervisors to concerns that trigger "responsive oversight" (a double-check or elaboration of trainees' clinical work). Supervisors sometimes engage in "backstage oversight" (oversight of which the trainee is not directly aware). When supervisors encounter a situation that exceeds a trainee's competence, they move beyond clinical oversight to "direct patient care".Conclusions: This study elaborates a typology of clinical oversight activities including routine, responsive, and backstage oversight. This new typology provides a framework for clinical supervision policy and for research to evaluate the relationship between supervision and safety.