Table 2.
Triggers for Responsive Oversight
| Themes and definitions | Representative transcript excerpts |
|---|---|
| Situation-specific | |
| Clinical cues | |
| Refers to specific clinical issues that trigger the supervisor to provide increased oversight | “Her patient presented with chest pain, and I wanted to go check for myself and get a sense could this be cardiac... I wanted to be very sure because there were very subtle clues in the history.” Team 11 Attending physician (ED) |
| Secondary source | |
| Refers to instances when input from someone outside the teaching team influences decisions about whether or not to provide oversight | “I called the staff person and told him ‘I asked the resident to look at (the patient) but she refused’...The staff doctor came up and this guy ended up going to the neuro ICU.” Nurse 7 (GIM) |
| “I know the nursing staff really well, so I will ask if they have any concerns about the patients with the housestaff and they will tell me.” Team 7 Attending physician (GIM) | |
| Language discrepancies | |
| Refers to instances where inaccuracies in terminology or in clinical information provided by trainees triggers increased oversight | “It was a patient we recently admitted and there was an abdominal ultrasound ordered because there was a lump, but the way the resident described it he didn’t convince me that there was actually something, so I had to go and repeat the examination.” Team 3 Attending physician (GIM) |
| “We had a patient with chest pain and the housestaff said ‘it’s not cardiac’, but I noticed some changes in the ECG...so I went in and took the history of her chest pain from the beginning again.” Team 7 Attending physician (GIM) | |
| General | |
| Clinical cues | |
| Refers to general clinical issues that trigger increased oversight activity relating to a given patient’s care over a period of time | “I guess well we had one sick person who was on our team who was probably going to die. The patient was initially being taken care of by a medical student and I just wanted to make sure that we were doing everything appropriate, so I was seeing the patient with them a lot”. Team 1 Senior resident (GIM) |
| Ability of trainee | |
| Refers to instances where a supervisor’s level of comfort with a trainee’s abilities affects decisions about oversight | “Somebody that I am just starting to work with will get a lot more supervision than someone I am familiar with...” Team 10 Attending physician (ED) |
| “I have a lot of confidence in these medical students, so I didn’t actually go to the bedside and we just reviewed things together in terms of the work and the plan and things like that. Only if I really trust the work and I have been working with them for awhile, so I am more comfortable not checking.” Team 5 Senior resident (GIM) | |