Discordance exists between supervising physicians and residents regarding which scenarios require supervising physicians’ input, according to a study.
The study was based on responses to an anonymous online survey of pediatric residents, internal medicine/pediatric residents, and fellows and attending physicians of hospital medicine service, hematology/oncology, gastroenterology, and pulmonology at MassGeneral Hospital for Children (MGHfC) in Boston. Respondents included 62 of 67 eligible residents and 50 of 56 eligible supervising physicians, which included both the attendings and fellows. The survey presented 34 scenarios encountered by residents doing after-hours coverage on a general pediatric floor. The survey asked whether after-hours residents should contact supervising physicians immediately or delay communication to the next day, for each scenario.
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“Responses were statistically significantly different between residents and supervising physicians in 17 of the 34 scenarios (50%). In all 17 of these scenarios without exception, more supervising physicians wanted immediate communication, compared with the residents,” wrote Dr. Deepak Palakshappa, chief pediatric resident at the time of the study and currently an instructor at Children’s Hospital of Philadelphia, and his colleagues.
The 17 scenarios under which discordance of opinions existed between the two groups fell under the categories of clinical, laboratory/radiology, and logistical/social. The clinical scenarios under which the greatest discrepancies between the two groups occurred were a new fever in an otherwise well patient (odds ratio, 11.49; P less than .001) and an increasing oxygen requirement in a patient already on oxygen (OR, 6.27; P less than .001).
The laboratory/radiology scenario with the largest discrepancy on whether a supervising physician should be immediately contacted was a new radiographic finding (OR, 7.72; P less than .001). One of the logistical/social scenarios over which members of the two groups most often disagreed on the timing of notifying a supervising physician was in the case of an angry parent or family member (OR, 15.67; P less than .001).
Among the study’s other findings was that 32% of all residents knew that the hospital had communication guidelines for addressing various work scenarios, at the time the researchers were conducting the study.
“Future studies should evaluate whether and how these communication preferences actually translate into changes in actual behaviors and subsequent patient care outcomes,” the researchers said.
Read the study in the Journal of Pediatrics (doi: 10.1016/j.peds.2015.08.052).