Perception that the attending physician does not want to be called. Attending physicians often communicate a call-me-but-don't-call-me message to residents, which prevents residents from reaching out. “An attending will say, 'Here's my pager and my cell phone. Call me anytime, but I'm going to be at a dinner,' ” Farnan says. “Clearly that sends a message of 'Don't call me.'" Not answering calls or pages or chastising residents for calling also lessens the likelihood residents will reach out when they need help.
Attending physicians must take steps to facilitate supervision, but they need training and support from program leadership.
“People assume that you graduate from residency and you know how to be a good supervisor. Sometimes that's the case, and sometimes it's not,” Arora says.
The following tips will help faculty members become better at providing supervision and also eliminate many of the barriers residents face when asking for help:
Set clear expectations up front. Specifically outline in what circumstances you want the resident to notify you about a patient's condition. For example, Farnan tells residents that she wants them to call her anytime an end-of-life decision arises, or when a patient suffers an adverse event, dies, or goes to the ICU. Residents write these instructions on the sign-out sheets, and Farnan receives calls from the cross-cover residents caring for her patients, too.
Also, establish a time every night at which the resident will call you, such as 10 p.m. Recognize that residents get busy and may forget to call. If that is the case, attending physicians should take responsibility and page the residents, Arora says.
Be available. Attending physicians should answer all calls while on service. Some attending physicians may think that not responding or not providing residents guidance when asked promotes trainees' autonomy, but that's not the case. Instead, absentee attendings often cause residents to feel abandoned, Arora says.
Address uncertainty. Faculty members should assure residents, especially junior trainees, that uncertainty is part of education and they should not feel bad about asking for help.