We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Supervision: A 2-Way Street

Jeanne Marie Farnan, MD; Holly J. Humphrey, MD; Vineet Arora, MD, MA
Arch Intern Med. 2008;168(10):1117. doi:10.1001/archinte.168.10.1117-a.
Text Size: A A A
Published online


We commend Singh et al1 on their thought-provoking and important work. While we certainly agree that patient handoffs are rife with the potential for error and patient harm secondary to breakdowns in communication,2 laying the onus of supervision squarely on the attending physician is an issue we call into question.

The struggle between resident autonomy and the duty to supervise is constant, with trainees wishing to assert their independence and the hidden curriculum reinforcing their actions.3 Levels of supervision have been defined within specific specialties, such that there is a graded amount of attending physician involvement: direct, which requires the physical presence of the attending physician during the key aspect of patient care; participatory, with faculty providing oversight before or during the care of the patient; and indirect, which involves the faculty reviewing the care given to patients by examination of medical records or discussion of treatment plan.4 It is important to note that indirect supervision, which is most commonly adopted and used in nonprocedural specialties, can be misperceived as a lack of supervision in some cases. In these instances, residents may actively discourage involvement by the attending physician. In fact, an overly involved attending physician is perceived as invasive and having a lack of faith in the team's clinical competence.5 Moreover, the Accreditation Council for Graduate Medical Education stresses providing and promoting resident autonomy in clinical care.6 The control of the struggle between autonomy and supervision lies squarely with the resident physician, since they choose to engage their attending physician in their decision making. Often it is not that the attending physician is not participating in decision making because of a failure to supervise, but that they are not aware of the decisions being made by their resident.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Medical Decision-Making Capacity

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Make the Diagnosis: Medical Decision-Making Capacity