BACKGROUND: Postgraduate year-1 residents (PGY-1s) begin clinical practice in a setting where attending staff and senior residents are available to supervise their work. There is an expectation that, while being supervised and as they become more experienced, the PGY-1s will gradually take on more responsibilities and function independently.
OBJECTIVE: To determine the degree of agreement between the level of supervision expected by clinical supervisors (CSs) and the level of supervision reported by PGY-1s.
METHODS: Using a nominal group technique, subject matter experts (SMEs) from multiple specialties defined “entrustable professional activities” (EPAs) for PGY-1s, that is, a set of activities to be performed independently by PGY-1s by the end of their first year of residency, regardless of specialty. We then surveyed and compared CSs and PGY-1s from one institution regarding levels of supervision expected and received during the daytime and nighttime for each EPA.
RESULTS: The SMEs defined 10 EPAs (e.g., completing admission orders, obtaining informed consent), ratified by a national panel, and 113 CSs and 48 PGY-1s completed the survey. CSs had the same expectations regardless of the time of day. For three EPAs (managing intravenous fluids, obtaining informed consent, and obtaining advanced directives) the level of supervision reported by PGY-1s was lower than what CSs expected (p<0.001) regardless of the time of day (i.e., day versus night). For four more EPAs (initiating the management of critically ill patients, handing over the care of patients to colleagues, writing discharge prescriptions, and coordinating a patient discharge) the differences only occurred during nighttime work (p0.001).
CONCLUSION: PGY-1s reported performing EPAs with less supervision than expected by CSs, especially during nighttime work. Using EPAs to guide the content of the undergraduate curriculum and during examinations could help better align CSs’ and PGY-1s’ expectations about early residency supervision
