Development of a Novel Curriculum to Enhance the Autonomy and Motivation of Residents

Abstract

Teaching hospitals nationwide have experienced intense pressures on patient care systems that in the past provided a nurturing home for resident education. Increased regulatory burdens and the drive to increase revenues, among other changes, have placed severe constraints on resident and faculty time for education. In our pediatric residency program at the University of Rochester Medical Center, a symptom of these changes has been a perceived erosion of resident autonomy. Faculty have reported that residents are reticent to generate their own patient care plans, whereas residents have stated that faculty are overly directive and do not always take the time to listen to their assessment and plan. Recently, a resident “delegation” brought to our faculty a proposed educational contract, the purpose of which was to increase resident responsibilities for initiation of patient care plans and clarify the responsibility of the faculty to provide timely and constructive feedback on these plans. This contract has been received with enthusiasm by the faculty. It provides an ideal opportunity for introduction of our new curriculum to enhance resident autonomy, which will be implemented and tested over the next several years. We believe that the competency domain of practice-based learning and improvement, which is often challenging for residents, may be enriched by the application of self-determination theory (SDT), a body of knowledge and tools that has proven effective in business, education, athletics, and health care to enhance motivation.1,–,5 SDT was developed by 2 University of Rochester psychologists: Professors Edward Deci and Richard Ryan. It teaches that people who cultivate intrinsic motives to pursue goals are higher achievers than those who are prodded to perform by extrinsic rewards and punishments. The theory posits that human motivation is driven by psychological need fulfillment in 3 areas: autonomy (the need to … Address correspondence to William S. Varade, MD, University of Rochester Medical Center, 601 Elmwood Ave, Box 777R, Rochester, NY 14642. E-mail: william_varade{at}urmc.rochester.edu