Pediatric residents and their supervising physicians disagree about when the residents should reach out to ask for help during after-hours situations, according to research. In certain situations, even supervisors disagree among themselves.
The study, published in the Journal of Pediatrics, surveyed all Massachusetts General Hospital for Children residents in pediatrics and their supervising physicians regarding 34 scenarios related to clinical situations.
"We had theorized prior to this study that differences in communication would exist among members of the healthcare team, but the magnitude of the differences was surprising to us, along with the disagreements among attendings, many in the same division," Deepak Palakshappa, MD, chief pediatric resident at the time of the study and current instructor at the Children's Hospital of Philadelphia, said in a statement. "This study provides a first step toward improving supervision of pediatric medical trainees by defining these significant differences in communication preferences."
Researchers found senior attending physicians were more likely than junior attending physicians to prefer immediate notifications for situations such as worsening pain, the need for restraints and patient falls.
There was no significant difference in the responses of the residents based on how far into their training they were, but the most striking differences were in logistical or social situations, including angry family members or aggressive patient behavior. In those scenarios, residents preferred to hold off consultation until the following day while supervisors preferred immediate consultation.
"Balancing the need for residents to develop autonomy with the level of supervision required to ensure safe and appropriate patient care is challenging," Chadi El Saleeby, MD, senior author of the report, said in a statement. "The variations we found between residents and attendings — and even more so among attendings — highlight the need for more structured, formal guidelines within programs and institutions."