Abstract
Background: Although graduated autonomy is an essential component of residency training, we have an incomplete understanding of resident and attending faculty perceptions of autonomy.Objective: In this study, we assessed differences in perceived autonomy among residents and faculty in pediatrics, internal medicine, and combined internal medicine-pediatrics. Methods: We surveyed senior-level (PGY-2-5) residents and faculty in pediatrics, internal medicine, and combined internal medicine-pediatrics in three large, urban training centers in November 2014. The survey included domain items such as general perceptions of autonomy, case management, rounding structure, and individual resident and faculty factors that may interplay with the granting or receiving of autonomy. Results: Of 489 eligible respondents, 215 (44%) responded. Internal medicine-pediatrics residents were more likely than categorical pediatrics residents and pediatrics faculty to disagree that they received an appropriate level of autonomy while on inpatient pediatrics general wards (mean = 2.7 relative to 4.0 and 4.3, categorical residents and faculty; 5-point Likert scale; P < .001). On a 5-point Likert scale, the internal medicine-pediatrics residents were more likely to agree that they received too much oversight on pediatrics general ward rotations (mean, 3.9) compared to internal medicine general ward rotations (mean, 1.9) with a P-value between rotations of <.001. Combined internal medicine-pediatrics perceptions of too much oversight while on pediatric general ward rotations were significantly different from their categorical pediatrics peers (pediatrics mean 2.0, P < .001). Conclusions: Internal medicine-pediatrics residents have differing perceptions of autonomy from their categorical peers as well as categorical supervising faculty. Combined Internal medicine-pediatrics residents' perceived oversight on pediatrics rotations differently from their categorical pediatrics peers and also differently from their experiences on internal medicine wards. A better understanding of combined internal medicine-pediatrics residents' perceptions of autonomy and supervision can help inform future work regarding autonomy-supportive strategies to optimize learning.
Highlights
Graduated autonomy is an essential component of residency training across medical specialties [1]
Categorical internal medicine (IM) residents and pediatrics residents either strongly agreed or agreed that they received an appropriate level of autonomy
MP residents strongly agreed that they received an appropriate level of autonomy while on inpatient IM general wards, and disagreed that they received an appropriate level of autonomy while on inpatient pediatrics wards
Summary
Graduated autonomy is an essential component of residency training across medical specialties [1]. Previous research suggests that a perceived optimal level of autonomy may result in fewer medical errors as well as higher support for patient autonomy [4,5,6]. An autonomy-supportive learning environment is more likely to promote self-directed learning and lead to enhanced medical knowledge and skills [7,8]. Mismatches in autonomy perception in the resident-attending dyad may result in dissatisfaction with the learning environment, decreased learning, and increased trainee stress in the clinical environment [4]. Graduated autonomy is an essential component of residency training, we have an incomplete understanding of resident and attending faculty perceptions of autonomy
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