Anesthesiology residents' and nurse anesthetists' perceptions of effective clinical faculty supervision by anesthesiologists.

Abstract

Often anesthesia care is provided by nonfaculty anesthesia providers (e.g., anesthesiology residents and certified registered nurse anesthetists [CRNAs]) under the guidance of faculty anesthesiologists. Performance appraisal of faculty anesthesiologists should therefore include evaluation of this guidance. Residents and CRNAs from 3 teaching hospitals gave their "impression of 9 attributes of the hypothetical supervising anesthesiologist who meets … expectations … not … who exceeds expectations or whose activity is below … expectations." Scores were based on the anesthesiologist working with the respondent, not others. A 4-point scale (e.g., 1 = never, 2 = rarely, 3 = frequently, and 4 = always) was used, and the mean was calculated. The participation rate was 51% among CRNAs (N = 153) and 58% among resident physicians (N = 47). There was no association between years since the start of training and supervision scores that met expectations among CRNAs (Kendall τb = 0.01; 95% confidence interval [CI], -0.13 to +0.10; P = 0.90) or residents (τb = 0.03; 95% CI, -0.16 to +0.23; P = 0.77). Most CRNAs (67%) and residents (94%) perceived that supervision that met their expectations was at least "frequent" (score ≥3.0) (both P < 0.0001). The mean ± SD of supervision scores that met expectations was 3.14 ± 0.42 for CRNAs versus 3.40 ± 0.30 for residents. The CRNAs' score mean was 0.26 less than that of residents (P < 0.0001; 95% CI, 0.15 to 0.37 less). There were 30% of CRNAs with scores larger than the residents' mean. Most CRNAs and residents at 3 teaching hospitals considered faculty guidance that meets expectations to be at least "frequent," regardless of years in practice.