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Clinical oversight: conceptualizing the relationship between supervision and safety
Tara J T Kennedy1, Lorelei Lingard, G Ross Baker
1Bloorview Kids Rehab, Toronto, ON, Canada. tara.kennedy@utoronto.ca
Journal of General Internal Medicine
|June 9, 2007
Summary
This study defines clinical oversight activities, including routine, responsive, and backstage oversight, to improve medical trainee supervision and patient safety. The new typology aids policy and research for better healthcare quality.
Area of Science:
- Medical Education
- Healthcare Quality Improvement
- Clinical Supervision
Background:
- Increased medical trainee supervision aims to enhance healthcare safety and quality.
- Current supervision models are poorly defined, hindering evaluation of their impact on patient care and education.
Purpose of the Study:
- To develop a conceptual model of clinical supervision.
- To inform policy and guide future research in medical education.
Main Methods:
- Conducted observational fieldwork and interviews in academic health centers.
- Analyzed field notes and interview transcripts from 88 participants across 12 teaching teams using grounded theory.
- Included physicians, residents, medical students, and nurses in the study.
Main Results:
- Introduced the term "clinical oversight" for supervisor activities ensuring care quality.
- Identified three types of oversight: routine (preplanned monitoring), responsive (double-checking), and backstage (unaware to trainee).
- Supervisors engage in direct patient care when trainee competence is exceeded.
Conclusions:
- Elaborated a typology of clinical oversight: routine, responsive, and backstage.
- This framework supports clinical supervision policy development.
- Provides a basis for research evaluating supervision's link to patient safety.
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