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Master Thesis

Séniorisation aux urgences, autonomisation des internes et juste distance d'encadrement : enquête auprès des internes et des urgentistes d'Aquitaine

Abstract : Introduction: The balance between the residents’ supervision during emergency clerkship and the their necessary autonomy is difficult. We have checked if self- assessment from residents and assessment from emergency supervisors were different about autonomy speed. We have checked whether or not residents’ self assessments and assessment from emergency physicians regarding the speed of autonomy, were different. We looked for the points showing that the supervision distance is unadapted and the reasons associated with quick autonomy. Methods: This survey carried out in the French region of Aquitaine, compares residents that did their emergency clerkship with the physicians of 19 emergency departments. A questionnaire was sent to all of them from April 2013. Results: 74% of residents and 53% of emergency physicians completed the questionnaire. Out of 428 residents, 207 had already done their emergency clerkship. The main outcome showed no major difference ; empowerment was perceived slow for 2% and 7%, adequate for 73% and 69%, and quick for 25% and 26% respectively (p=0,11). Assessments of supervision sometimes differed for supervision distance in some details. A quick autonomy was associated with a low level of supervision of clinical reasoning (OR=4,6 [IC95% 1,8-11,9] ; p=0,004), to unclear responsability (OR=3,3 [IC95% 1,4-7,9] ; p=0,005), and to residents’ feeling that they compensate for the lack of emergency physicians (OR=4 [IC95% 1,7-9,8] ; p<0,001) which is shared by 80% of residents and half of emergency physicians. Discussion: Residents and emergency physicians share the same assessment regarding autonomy speed. But we showed some points of divergence on specific items that should be the focus of increased attention. The practice of regular mutual feedback between residents and emergency physicians needs to be developped to continuously improve empowerment. A constructive mid-clerk ship debriefing delivered early enough to implement corrective measure s is unanimously requested by residents and supervisors.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01202596
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, September 21, 2015 - 1:55:41 PM
Last modification on : Wednesday, August 23, 2017 - 4:30:48 PM

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Thibault Viard. Séniorisation aux urgences, autonomisation des internes et juste distance d'encadrement : enquête auprès des internes et des urgentistes d'Aquitaine. Médecine humaine et pathologie. 2015. ⟨dumas-01202596⟩

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