Lack of Supervision and Independent Clinical Decision Making in Postgraduate Pediatric training in Australia
Bibliographic record
Abstract
OBJECTIVE: Evaluation of postgraduate pediatric training is a complex yet critical task. We aimed to review pediatric trainees' attitudes to clinical decision-making, levels of supervision and end of life issues in a tertiary pediatric teaching hospital in Sydney, Australia. METHOD: A questionnaire was devised and distributed to all trainees at Sydney Children's Hospital, Randwick. All responses were anonymous. Results were independently analyzed using SPSS statistical software. RESULTS: Forty percent of trainees spent three hours or less per week face to face with more senior colleagues and 14% spent greater than 10 hours per week with more senior colleagues. Seventy-five percent of trainees spent three hours or less on the phone with more senior colleagues while 10% spent five hours or more on the phone with more senior colleagues. There was no association (or correlation) (p>0.05) between seniority of trainee and the number of times a trainee met face to face or phoned a more senior colleague to discuss a management plan. One in three trainees felt that they made less than 10% of clinical decisions on their own and 54% felt that they made less than half of decisions on their own. There was a statistically significant difference between seniority of training and the percentage of important clinical decisions made (p<0.01). Nearly half the trainees (47.7%) have not had the occasion to inform families of the death or impending death of a child. There was a statistically significant difference between seniority of training and the opportunity of informing families of a death of a child (p<0.01).Greater than two thirds of trainees feel that they have not received formal training in clinical decision-making. At the completion of four years of pediatric training only half the trainees considered themselves to be making the majority of clinical decisions. CONCLUSION: There is a need for closer supervision of pediatric trainees by senior colleagues, who themselves, may require additional ongoing training to supervise appropriately. There should be a balanced environment where trainees can make safe, independent decisions. The perceived absence of clinical decision making training suggests a deficiency in the training program.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".