TY - JOUR
T1 - Supervision and autonomy of ophthalmology residents in the outpatient clinic in the United States II
T2 - A survey of senior residents
AU - Singman, Eric L.
AU - Boland, Michael V.
AU - Tian, Jing
AU - Green, Laura K.
AU - Srikumaran, Divya
AU - Barkmeier, Andrew J.
AU - Hendershot, Andrew J.
AU - Thliveris, Andrew
AU - Moore, Daniel B.
AU - Wudunn, Darrell
AU - Goldman, David J.
AU - Waxman, Evan L.
AU - Domeracki, Gary
AU - Legault, Gary L.
AU - Pettey, Jeff
AU - Chen, John J.
AU - Olson, Joshua H.
AU - Winokur, Jules
AU - Colyer, Marcus
AU - Mayers, Martin
AU - Wilkinson, Michael J.
AU - Lee, Michael S.
AU - Syed, Misha
AU - Drucker, Mitchell
AU - Weikert, Mitchell P.
AU - Taravati, Parisa
AU - Veldman, Peter
AU - Challa, Pratap
AU - Blomquist, Preston H.
AU - Siatkowski, R. Michael
AU - Granadier, Robert
AU - Havens, Shane
AU - Culican, Susan M.
AU - Uhler, Tara A.
AU - Whittaker, Thomas J.
N1 - Publisher Copyright:
© 2019 The Author(s).
PY - 2019/6/13
Y1 - 2019/6/13
N2 - Background: A balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress. Methods: A survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress. Results: Category 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category. Conclusions: The presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents' perception of stress or their success in fellowship matching.
AB - Background: A balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress. Methods: A survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress. Results: Category 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category. Conclusions: The presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents' perception of stress or their success in fellowship matching.
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U2 - 10.1186/s12909-019-1620-0
DO - 10.1186/s12909-019-1620-0
M3 - Review article
C2 - 31196084
AN - SCOPUS:85067233753
SN - 1472-6920
VL - 19
JO - BMC medical education
JF - BMC medical education
IS - 1
M1 - 202
ER -