Summary: In response to a congressional request, GAO reviewed Veterans Administration (VA) hospitals' supervision of surgical residents to determine whether: (1) the supervision is adequate; (2) VA is monitoring this supervision; and (3) the supervision in VA hospitals is comparable to that in non-VA hospitals.
GAO reviewed surgical resident supervision at 10 VA and 15 non-VA hospitals and sent questionnaires to supervising surgeons and residents at 28 VA hospitals. GAO noted that, since VA supervision criteria were too broad, it developed its own more specific criteria establishing the minimum supervision needed to ensure quality patient care and effective resident training. GAO found that: (1) compliance with GAO intraoperative criteria was generally adequate; (2) compliance with the preoperative and postoperative criteria was insufficient; (3) hospital enforcement of VA criteria varied, affecting residents' supervision; and (4) only 34 percent of the 148 surgical cases reviewed were in compliance with all the GAO criteria. VA primarily monitors supervision by reviewing annual audits that VA hospitals submit; however, GAO found that: (1) 33 percent of the hospitals did not submit the results of their audits for fiscal year 1984; (2) only one of the reports submitted contained enough information to monitor preoperative, intraoperative, and postoperative supervision; (3) VA headquarters had not told the regional directors responsible for enforcing the audit requirement which VA hospitals had not complied; and (4) VA hospitals had not issued specific requirements for monitoring supervision, causing the quality to vary. GAO also found that the level of VA hospital supervision was slightly lower than that at non-VA hospitals, perhaps due to lack of incentives such as reimbursement requirements.
