“Call Me, Maybe”: Supervisor and Resident Comfort With Indirect Supervision in Psychiatry Training

Abstract

Resident supervision is critical for education and ensuring patient safety. After hours, communication with attendings is variable. The objective was to identify differences among psychiatry residents and attendings regarding the desired level of supervision for issues that arise overnight in the psychiatric emergency department (ED). In a single-site psychiatric ED, an electronic survey containing 30 hypothetical scenarios was administered. For each scenario, residents were asked if they would call attendings and attendings whether they would want to be called. 35/44 psychiatry residents and 15/17 faculty participated, yielding a response rate of 82%. For five scenarios, faculty preferred that residents call for supervision more frequently than residents indicated they would. These included staff or house staff injuries (60% vs. 22.9%, p = 0.011; 93.3% vs. 62.9%, p = 0.039), a patient using heroin in the ED (53.3% vs. 5.7%, p < 0.001), a conflict with the medical ED attending (100% vs. 65.7%, p = 0.010), and a decision about calling in a backup resident (60% vs. 28.6%, p = 0.036). In a psychiatric ED, attendings prefer greater involvement in cases relating to psychosocial issues, legal concerns, and conflicts with patients. More work is needed to fully understand these differences and their potential impact on patient care and training.