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Measuring the Intensity of Resident Supervision in the Department of Veterans Affairs: The Resident Supervision Index

Byrne, John M. DO; Kashner, Michael PhD, JD; Gilman, Stuart C. MD, MPH; Aron, David C. MD, MS; Cannon, Grant W. MD; Chang, Barbara K. MD, MA; Godleski, Linda MD; Golden, Richard M. PhD; Henley, Steven S. MS; Holland, Gloria J. PhD; Kaminetzky, Catherine P. MD, MPH; Keitz, Sheri A. MD, PhD; Kirsh, Susan MD; Muchmore, Elaine A. MD; Wicker, Annie B.

doi: 10.1097/ACM.0b013e3181d5a954
Graduate Medical Education

Purpose: To develop a survey instrument designed to quantify supervision by attending physicians in nonprocedural care and to assess the instrument's feasibility and reliability.

Method: In 2008, the Department of Veterans Affairs (VA) Office of Academic Affiliations convened an expert panel to adopt a working definition of attending supervision in nonprocedural patient care and to construct a survey to quantify it. Feasibility was field-tested on residents and their supervising attending physicians at primary care internal medicine clinics at the VA Loma Linda Healthcare System in their encounters with randomly selected outpatients diagnosed with either major depressive disorder or diabetes. The authors assessed both interrater concurrent reliability and test–retest reliability.

Results: The expert panel adopted the VA's definition of resident supervision and developed the Resident Supervision Index (RSI) to measure supervision in terms of residents' case understanding, attending physicians' contributions to patient care through feedback to the resident, and attending physicians' time (minutes). The RSI was field-tested on 60 residents and 37 attending physicians for 148 supervision episodes from 143 patient encounters. Consent rates were 94% for residents and 97% for attending physicians; test–retest reliability intraclass correlations (ICCs) were 0.93 and 0.88, respectively. Concurrent reliability between residents' and attending physicians' reported time was an ICC of 0.69.

Conclusions: The RSI is a feasible and reliable measure of resident supervision that is intended for research studies in graduate medical education focusing on education outcomes, as well as studies assessing quality of care, patient health outcomes, care costs, and clinical workload.

Dr. Byrne is associate chief of staff for education, VA Loma Linda Healthcare System, Loma Linda, California, and assistant professor of medicine, Loma Linda University School of Medicine, Loma Linda, California.

Dr. Kashner is associate director for program evaluation, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and professor, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Dr. Gilman is director of advanced fellowships and professional development, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and clinical professor of health science, University of California, Irvine, Irvine, California.

Dr. Aron is associate chief of staff for education, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, and professor of medicine, Case Western University School of Medicine, Cleveland, Ohio.

Dr. Cannon is associate chief of staff for education, George E. Wahlen VA Medical Center, Salt Lake City, Utah, and professor of medicine and Thomas E. and Rebecca D. Jeremy Presidential and Endowed Chair for Arthritis Research, University of Utah School of Medicine, Salt Lake City, Utah.

Dr. Chang is director, Medical and Dental Education, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC, and professor of medicine (emeritus), University of New Mexico School of Medicine, Albuquerque, New Mexico.

Dr. Godleski is associate chief of staff for education, VA Connecticut Healthcare System, New Haven, Connecticut, and associate professor of psychiatry, Yale School of Medicine, New Haven, Connecticut.

Dr. Golden is professor of cognitive science and engineering and program head, Undergraduate Cognition Science Program and Masters Program in Applied Cognition and Neuroscience, The School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas.

Mr. Henley is president, Martingale Research Corporation, Plano, Texas.

Dr. Holland is special assistant for policy and planning, Office of Academic Affiliations, Department of Veterans Affairs, Washington, DC.

Dr. Kaminetzky is associate chief of staff for education, Durham VA Medical Center, Durham, North Carolina, and assistant professor of medicine, Duke University School of Medicine, Durham, North Carolina.

Dr. Keitz is chief, Medical Service, Miami VA Medical Center, Miami, Florida, and associate dean, Miller School of Medicine, University of Miami, Miami, Florida.

Dr. Kirsh is associate professor of medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Dr. Muchmore is associate chief of staff for education, San Diego VA Medical Center, San Diego, California, and professor of clinical medicine and vice chair for education, Department of Medicine, University of California, San Diego, San Diego, California.

Ms. Wicker is research health science specialist, VA Loma Linda Healthcare System, Loma Linda, California.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Byrne, Jerry L. Pettis Memorial VA Medical Center (14A), VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA 92357; telephone: (909) 583-6004; fax: (909) 777-3828; e-mail: john.byrne3@va.gov.

© 2010 Association of American Medical Colleges