The Effectiveness of Direct Supervision by an Attending Compared To a Senior Resident on Quality of Supervision of Novice Anesthesiology Residents: A Randomized Study.

Abstract

New trainees are directly supervised by either an attending physician or a senior resident under indirect supervision from an attending physician. The main objective was to evaluate which type of direct supervision (attending vs. senior resident) would result in better quality of supervision to novice residents during their first month of training. Novice anesthesiology residents were randomized to receive direct supervision by an attending anesthesiologist or a senior resident during their introduction month of intraoperative anesthesia. The primary outcome was a validated instrument to evaluate supervision performance of the instructor. The secondary outcome was a validated anxiety scale. The overall mean supervision score across the study days was greater in the residents who were directly supervised by attendings, mean (standard error [SE]) of 3.88 ± 0.03 compared with direct supervision by a senior resident, mean (SE) of 3.77 ± 0.03 a mean difference of 0.11 (95% confidence interval [CI], 0.05-0.16), P = .0012. Five of 9 individual items on the supervision survey were significantly greater in the group directly supervised by attendings compared with residents. There was no difference between groups regarding anxiety scores. In contrast, there was a mild association between supervision scores and Spielberger State-Trait Anxiety Inventory-6 anxiety scores, correlation coefficient = 0.23 (95% CI, 0.08-0.39), P < .0035. We detected better supervision scores when novice anesthesiology residents were directly supervised by attendings when compared with senior residents. Nevertheless, direct supervision by senior residents still provided supervision scores consistent with a safe supervision practice.