Attending physician variability: a model of four supervisory styles

Area of Science:

• Medical Education Research
• Physician Supervision
• Academic Medicine

Background:

• Attending physician roles in teaching teams show significant variability in patient care and trainee education.
• Understanding this variability is crucial for optimizing clinical learning environments.

Purpose of the Study:

• To explore and categorize the different ways attending physicians configure and rationalize their roles in direct patient care, trainee oversight, and teaching.
• To identify distinct supervisory styles adopted by attending physicians on academic medical teams.

Main Methods:

• A constructivist grounded theory approach was employed for data collection and analysis.
• Interviews were conducted with 24 attending physicians at two academic centers in Ontario, Canada.
• Participants reflected on a hypothetical case presentation within the context of their typical team interactions.

Main Results:

• Four distinct supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist.
• Direct care prioritizes patient safety by minimizing trainee responsibility; empowerment focuses on progressive trainee independence.
• Mixed practice balances patient care and teaching based on competence and context; minimalist style trusts senior residents with significant autonomy.

Conclusions:

• The identified supervisory styles represent diverse responses to inherent role and contextual tensions in attending physician practice.
• Further research, including observational studies, can refine this model and explore contextual influences.
• Explicitly defining and discussing these supervisory styles may improve attending physician effectiveness and team competence.