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Supervision and Responses of Psychiatry Residents to Adverse Patient Events

  • Empirical Report
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Abstract

Objective

Throughout training, psychiatry residents may experience adverse patient outcomes. The purpose of this study was to explore whether residents’ perceptions of the quality of their supervision impacts their emotional reactions to adverse events.

Methods

All psychiatry residents from a training program at an academic medical center who were in their PGY2–4 years, as well as those in their first year out of training, were recruited to participate. Those who self-identified as having experienced an adverse event participated in a semi-structured interview. For the purpose of the study, “adverse event” was defined as follows: patient suicide, patient homicide or homicide attempt outside the hospital, patient violence inside the hospital, life-threatening reaction to psychotropic medication, and physical assault of a resident by a patient.

Results

In this sample, 22 of the 64 residents (34 %) reported experiencing an adverse event. Of these, 21/22 (95 %) participated in the interview. Two residents reported experiencing two adverse events; the total number of adverse events analyzed was 23. For 21/23 (91 %) of these events, respondents felt that the quality of the supervision they received impacted their emotional reactions to the event.

Conclusion

The supervisory relationship appears to play a significant role in how residents experience, and potentially learn from, adverse events; this has practical implications for educators and leaders.

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References

  1. Brown HN. Patient suicide during residency training. 1. Incidence, implications, and program response. J Psychiatr Educ. 1987;11(4):201–16.

    Google Scholar 

  2. Pilkinton P, Etkin M. Encountering suicide: the experience of psychiatric residents. Acad Psychiatr. 2003;27(2):93–9.

    Article  Google Scholar 

  3. Ruskin R, Sakinofsky I, Bagby RM, Dickens S, Sousa G. Impact of patient suicide on psychiatrists and psychiatric trainees. Acad Psychiatr. 2004;28(2):104–10.

    Article  CAS  Google Scholar 

  4. Schwartz TL, Park TL. Assaults by patients on psychiatric residents: a survey and training recommendations. Psychiatr Serv. 1999;50(3):381–3.

    CAS  PubMed  Google Scholar 

  5. Dvir Y, Moniwa E, Crisp Han H, Levy D, Coverdale J. Survey of threats and assaults by patients on psychiatry residents. Acad Psychiatr. 2012;36(1):39–42.

    Article  Google Scholar 

  6. Ruben I, Wolkon G, Yamamoto J. Physical attacks on psychiatric residents by patients. J Nerv Ment Dis. 1980;168(4):243–5.

    Article  CAS  PubMed  Google Scholar 

  7. Kozlowska K, Nunn K, Cousens P. Adverse experiences in psychiatric training. Part 2. Aust N Z J Psych. 1997;31(5):641–52.

    Article  CAS  Google Scholar 

  8. Henn RF. Patient suicide as part of psychiatry residency. Am J Psychiatry. 1978;135(6):745–6.

    CAS  PubMed  Google Scholar 

  9. Schnur DB, Levin EH. The impact of successfully completed suicides on psychiatric residents. J Psychiatr Educ. 1985;9:125–36.

    Google Scholar 

  10. Lomax JW. A proposed curriculum on suicide care for psychiatry residency. Suicide Life Threat Behav. 1986;16(1):56–64.

    CAS  PubMed  Google Scholar 

  11. Sacks MH, Kibel HD, Cohen AM, Keats M, Turnquist KN. Resident response to patient suicide. J Psychiatr Educ. 1987;11(4):217–26.

    Google Scholar 

  12. Ellis TE, Dickey TO. Procedures surrounding the suicide of a trainee's patient: a national survey of psychology internships and psychiatry residency programs. Prof Psychol Res Pract. 1998;29(5):492–7.

    Article  Google Scholar 

  13. Ellis TE, Dickey TO, Jones EC. Patient suicide in psychiatry residency programs: a national survey of training and postvention practices. Acad Psychiatr. 1998;22(3):181–9.

    Article  CAS  Google Scholar 

  14. Courtenay KP, Stephens JP. The experience of patient suicide among trainees in psychiatry. Psychiatrist. 2001;25:51–2.

    Google Scholar 

  15. Biermann B. When depression becomes terminal: the impact of patient suicide during residency. Psychodyn Psychiatr. 2003;31(3):443–57.

    Google Scholar 

  16. Misch DA. When a psychiatry resident's patient commits suicide: transference trials and tribulations. Psychodyn Psychiatr. 2003;31(3):459–75.

    Google Scholar 

  17. Reeves G. Terminal mental illness: resident experience of patient suicide. Psychodyn Psychiatr. 2003;31(3):429–41.

    Google Scholar 

  18. Lafayette JM, Stern TA. The impact of a patient's suicide on psychiatric trainees: a case study and review of the literature. Harv Rev Psychiatr. 2004;12(1):49–55.

    Google Scholar 

  19. Coverdale JH, Roberts LW, Louie AK. Encountering patient suicide: emotional responses, ethics, and implications for training programs. Acad Psychiatr. 2007;31(5):329–32.

    Article  Google Scholar 

  20. Fang F, Kemp J, Jawandha A, Juros J, Long L, Nanayakkara S, et al. Encountering patient suicide: a resident’s experience. Acad Psychiatr. 2007;31(5):340–4.

    Article  Google Scholar 

  21. Mangurian C, Harre E, Reliford A, Booty A, Cournos F. Improving support of residents after a patient suicide: a residency case study. Acad Psychiatr. 2009;33(4):278–81.

    Article  Google Scholar 

  22. Melton BB, Coverdale JH. What do we teach psychiatric residents about suicide? A national survey of chief residents. Acad Psychiatr. 2009;33(1):47–50.

    Article  Google Scholar 

  23. Tsai A, Moran S, Shoemaker R, Bradley J. Patient suicides in psychiatric residencies and post-vention responses: a national survey of psychiatry chief residents and program directors. Acad Psychiatr. 2012;36(1):34–8.

    Article  Google Scholar 

  24. Lerner U, Brooks K, McNiel DE, Cramer RJ, Haller E. Coping with a patient's suicide: a curriculum for psychiatry residency training programs. Acad Psychiatr. 2012;36(1):29–33.

    Article  Google Scholar 

  25. Coverdale J, Gale C, Weeks S, Turbott S. A survey of threats and violent acts by patients against training physicians. Med Educ. 2001;35(2):154–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Marc Manseau, MD, MPH for his assistance with the analysis and presentation of the study data.

Disclosures

The authors report no competing interests.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emily Deringer.

Appendix. Structured Interview Questions

Appendix. Structured Interview Questions

Note: Bulleted questions below each main question represent additional questions that may or may not be asked during the interview, depending on the amount of detail elicited by the response to the initial question.

  1. A.

    What was the adverse event?

    1. a.

      Patient suicide

    2. b.

      Patient homicide or homicide attempt outside the hospital

    3. c.

      Significant patient violence in the hospital

    4. d.

      Severe adverse reaction to psychotropic medication

    5. e.

      Physical assault by a patient towards you

  2. B.

    Describe the event.

  3. C.

    In what year of training did this occur?

  4. D.

    How did you learn about what happened?

    • Where were you when you found out?

    • Who told you about the event?

  5. E.

    What were your initial reactions to the event?

    • Who were the first people you talked to?

    • What do you remember about these initial conversations?

    • What do you remember about how you felt and what you thought at the time?

  6. F.

    To what extent, if at all, did you feel personally responsible for the outcome? (This will also be distributed on paper to each participant)

    1. 1.

      Entirely responsible – It should have been avoided

    2. 2.

      Quite responsible

    3. 3.

      Somewhat responsible

    4. 4.

      Mildly responsible

    5. 5.

      Not at all responsible - all reasonable attempts were made to prevent this outcome

  7. G.

    Describe the supervision you received on the case prior to the event.

    • How often did you discuss the case with your supervisor?

    • How much autonomy were you given for the clinical decisions made on the case?

    • How much direct supervision (in which the supervisor was present during sessions with the patient) was involved?

  8. H.

    What is your sense of what is an appropriate level of supervision for a resident at the level of training you were at when the adverse event occurred?

    • How much direct supervision is appropriate at that level?

    • How much autonomy should a resident at that level have over management decisions?

  9. I.

    Do you think that the level of supervision you received was: (This will also be distributed on paper to each participant)

    1. 1.

      Too close – the supervisor micromanaged the case

    2. 2.

      Somewhat too directive

    3. 3.

      Appropriate

    4. 4.

      Somewhat lacking

    5. 5.

      Too hands-off - I felt that I had little attending back-up

  10. J.

    Is there any way that supervision on the case could have been improved?

    • What do you wish your supervisor had done differently?

  11. K.

    How has this event changed, if at all, how you approach your work today?

    • How has it changed, if at all, how you feel about your work?

    • Are there certain types of patients that remind you of this event?

    • What do you think might be different in your interactions with, or management of, those patients?

  12. L.

    If you had a similar adverse patient outcome now, do you think you would feel differently about it?

    • How might you cope differently with a similar bad outcome today?

  13. M.

    In what way, if at all, has this event changed the way you interact with supervisors?

  14. N.

    Do you think that the quality of the supervision you received had anything to do with the adverse event?

    • How could supervision be improved to lessen the likelihood of the outcome that occurred?

  15. O.

    Describe how the aftermath of the event was handled.

    • What happened on the unit/in the clinic to address the event?

    • How were you involved in any official reviews of the case at the hospital level? At the OMH level?

    • How much of these official responsibilities were handled by you and how much were handled by the supervisor?

    • How could the handling of the aftermath have been improved?

  16. P.

    Do you feel that the quality of the supervision you received in any way impacted your emotional reaction to the event?

    • How do you imagine that a different supervisory experience (either more positive or more negative) might have changed your reactions to the event that occurred?

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Deringer, E., Caligor, E. Supervision and Responses of Psychiatry Residents to Adverse Patient Events. Acad Psychiatry 38, 761–767 (2014). https://doi.org/10.1007/s40596-014-0151-6

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  • DOI: https://doi.org/10.1007/s40596-014-0151-6

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