A STRATEGY FOR IMPROVING THE SUPERVISION AND PERFORMANCE OF MOONLIGHTING RESIDENTS

Background. In 1990 the Ambulatory Care Service of the Ralph H. Johnso n Department of Veterans Affairs Medical Center, affiliated with the M edical University of South Carolina College of Medicine, developed wri tten clinical protocols for the management of patients with certain hi gh risk medical conditions. Method. Appropriateness of care was assess ed by determining physician compliance to the protocols over a 24-mont h period (October 1990-September 1992). All physicians who did not com ply received individualized feedback from the service chief. For the f irst 12 months, both staff physicians and moonlighting second- and thi rd-year medical residents were assessed (a total of seven staff physic ians and 20 residents participated in the study). For the second 12 mo nths, only the residents were assessed. Results. The moonlighting resi dents were notably less consistent than the staff physicians in protoc ol compliance (95-100% for the staff physicians; 78-100% for the moonl ighters). Additional interventions were then implemented to improve th e moonlighters' utilization of the protocols. Moonlighters' compliance over the subsequent 12 months was less variable (mean compliance of 9 2%, SD, 3%, the first year versus 95%, SD, 8%, the second year). Concl usion. The strategy seemed to improve the supervision and performance of the moonlighting residents and promoted consistent delivery of high -quality outpatient care.