Supervision in the outpatient clinic: effects on teaching and patient care

Two levels of faculty supervision in a resident teaching clinic were compared. Attending physicians recorded their impressions of diagnoses, treatment, severity of illness, and resident performance from case presentation alone and again after personally evaluating the patient. After direct evaluation, the attendings judged patients to be more seriously ill and rated resident performance lower. Changes in diagnosis and management were frequent. The attendings considered seeing the patient in person valuable for teaching in 18% of the cases, and for management in 27% of the cases. Faculty-patient interaction doubled supervisory time. Outpatient teaching and patient management are significantly affected when faculty see patients in person.