Progressive Autonomy Research Articles

Autism Spectrum Disorder (ASD) Law in Chile

The TEA Law ensures the right to equal opportunities and safeguards the social inclusion of children, adolescents and adults with ASD, eliminating any form of discrimination. It promotes a comprehensive approach in the social, health and education areas, and raises awareness in society on this issue. The law is based on fundamental principles such as dignified treatment, progressive autonomy, gender perspective, intersectorality, participation and social dialogue, early detection, continuous monitoring, and neurodiversity.

Comparative study of trans* healthcare models in Catalonia

Stigma and discrimination against the trans* community have been shown to exacerbate mental health issues among its members. In Catalonia, the Gender Identity Unit at the Clinic's Hospital traditionally adhered to a biomedical model (BMM) of health for trans* individuals. However, a few years ago, the Transit Service introduced a biopsychosocial model (BPSM). This observational cohort study explores the mental health effects in BMM compared to BPSM centers for trans* individuals.A web-based survey was employed to gather essential data, such as socio-demographics information, and mental health outcomes. All data was analyzed from the BPSM group (n = 81) and the BMM group (n = 21).The BPSM group exhibited statistically significant lower odds of experiencing emotional distress (p < 0.001). Other mental health outcomes indicated a trend toward lower odds in the BPSM group compared to the BMM group. Nevertheless, the prevalence of mental health problems were much higher than expected in general popupation, both groups presented depression rates of 35 % and 25.7 %, and anxiety rates of 45 % and 41.9 % (BMM and BPSM, respectively). Furthermore, these differences were also found when comparing to general population in Catalonia.Therefore, there is a pressing need to shift away from paternalistic medical roles and move towards informed decision-making and progressive autonomy. Perceiving the trans* experience as an individual desease, rather than an effect of societal norms on dissident bodies, has detrimental effects for the community. Additionally, the scientific community should listen to the demands of the trans* community and create space for trans* researchers in the production of knowledge.

From physician paternalism to patient autonomy: 25 centuries of history

From its origins, the doctor-patient relationship accompanied the social and cultural changes that have been modeling different forms of interhuman relationships. However, paternalism remained almost unchanged. Only in the 1970s, hand in hand with postmodern thought and the centrality of ethical, psychological, social and anthropological disciplines, respect for the autonomy of patients began to develop, which constituted the essence of a radical change. “Four models of doctor-patient relationship” are described depending on the objectives of the interaction between the actors, the doctor’s obligations and the patient’s values. Some particularities are detailed in the decision-making of children and adolescents, the doctrine of the mature minor, and progressive autonomy where the need for informed consent that reflects the autonomy of this age group is evident. It is worth highlighting the importance of communication in the development of a relationship in which the different models can collaborate with a genuine practice of autonomy for patients and their families.

Programmatic Efforts to Provide Progressively Autonomous Clinical Education Experiences

Context In previous research, athletic trainers (ATs) have identified the formal coursework and clinical experiences of their professional program as contributing to preparedness for autonomous practice. However, new graduates have reported a perceived lack of skills necessary for practicing autonomously. Objective The purpose of this study was to evaluate how programs provide progressively autonomous clinical education experiences and the role of these experiences in preparing future ATs. Design Qualitative study. Setting Virtual interviews. Patients or Other Participants A sample of 17 program administrators (program directors = 12, coordinators of clinical education = 5) representing 16 master of science in athletic training programs participated in this study. Main Outcome Measure(s) Each program completed a virtual interview guided by a semistructured interview protocol. A 3-person data analysis team identified emerging domains and categories through a multiphase approach. Member checking, multiple researcher triangulation, and auditing were used to establish trustworthiness. Results Four domains emerged from participant responses: (1) curricular design, (2) preparatory experience and outcomes, (3) preceptor role, and (4) assessments. We found that intentionality in curricular design to promote progressive autonomy was beneficial in facilitating transition to practice through improved knowledge, skills, and confidence. Due to the importance of clinical education in AT preparation, preceptors played a critical role in creating opportunities for learning in the clinical environment. However, the degree to which experiences were autonomous and the effectiveness of the student in those encounters were rarely measured. Limitations outlined by participants included accreditation and program length. Conclusions The development of knowledge, skills, and confidence through intentionally selected clinical experiences and guided by preceptor feedback are critical to establishing an autonomous practitioner. However, the program’s evaluations were predominantly traditional practice assessments and informal feedback, instead of an assessment of readiness for practice.

Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study.

Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.

Entrustment Decision Making in the Intensive Care Unit: It's About More Than the Learner.

The provision of graded supervision affording progressive autonomy is fundamental to the progression of a medical learner toward competency for independent practice; the decision of how much supervision versus autonomy to provide a trainee in the execution of clinical care constitutes an entrustment decision. Despite entrustment decision making occurring both daily in practice and summatively at points of matriculation through stages of medical training, the factors influencing entrustment decisions remain poorly understood across clinical contexts. This study was designed to explore the central research question: How are entrustment decisions made in the medical intensive care unit (ICU)? This qualitative case study used semistructured interviews with attending pulmonary and critical care physicians in the medical ICU at a major midwestern medical center to explore the entrustment decision-making process as it was enacted in the clinical environment. Five major themes emerged from the data: 1) task, circumstance, and trainee factors contribute to entrustment decision making; 2) ad hoc entrustment decisions are enacted by supervisors with a consideration of the care team as a unit, not only an individual; 3) autonomy does not only arise out of entrustment, but outcomes of prior autonomous actions by the trainee inform the intention to entrust; 4) entrustment decision making includes a social process of back-and-forth akin to negotiation; and 5) entrustment is a learned skill. The process of entrustment decision making in the ICU is more complex than prior frameworks have captured; a model with more complete incorporation of the factors that influence entrustment in the ICU is presented. It is not clear how often ad hoc entrustment decisions in clinical practice are primarily driven by factors pertaining directly to trainee competence, which carries implications in the use of entrustment for assessment.

Enhancing the Value of Surgical Entrustable Professional Activities through Integrative Learning Analytics

To demonstrate the value of integrating surgical resident Entrustable Professional Activity (EPA) data into a learning analytics platform that provides meaningful feedback for formative and summative decision-making. Description of the Surgical Entrustable Professional Activities (SEPA) analytics dashboard, and examples of summary analytics and intuitive display features. Department of Surgery, University of Wisconsin Hospital and Clinics. Surgery residents, faculty, and residency program administrators. We outline the major functionalities of the SEPA dashboard and offer concrete examples of how these features are utilized by various stakeholders to support progressive entrustment decisions for surgical residents. Our intuitive analytics platform allows for seamless integration of SEPA microassessment data to support Clinical Competency Committee (CCC) decisions for resident evaluation and provides point of training feedback to faculty and trainees in support of progressive autonomy.

Do the Behaviors of Early Childhood Education Teachers Promote Children's Progressive Autonomy? The Role of Interpersonal Emotional Regulation and its Consequences for Teachers' Occupational Well-Being

AbstractDespite its centrality within the Convention on the Rights of the Child, teachers’ behaviors promoting progressive autonomy, the psychological processes involved in their implementation and their consequences for teachers’ well-being has been neglected. Two studies assess early childhood teachers’ promoting progressive autonomy behaviors and their relationship with their strategies to regulate children’s emotions and their own job well-being. Overall, results support the presence of a virtuous circle where teachers use of strategies improving children’s emotions is associated to higher levels of progressive autonomy promotion and job well-being which in turn has been related to willingness to use affect improvement strategies.

Becoming a techie and improving your English with audiovisual translation

Abstract Audiovisual translation (AVT) as a tool in the teaching/learning of a foreign language has increasingly attracted the attention of researchers in the latest years. The TRADILEX Project team is currently working on the pedagogic use of AVT in the teaching /learning of English as a Foreign language (EFL) in an online environment, in a good number of Spanish universities. This paper presents the results of the TRADILEX experience, carried out at the University of Zaragoza (Spain). The methodology designed and applied for that end has required the use of technological tools to guide students through different steps, from an Initial Test of Integrated Skills (ITIS) to a Final Test of Integrated Skills (FITIS), both designed by members of the team. On their way from the former to the latter, students were invited to carry out a series of B1-level tasks in five AVT modes. The materials previously designed and tested aimed at a progressive autonomy of the student in their advance in the lesson plans of each mode. The analysis of the results obtained in each of the AVT modes, as well as the comparative results between the ITIS and the FITIS will highlight the virtues of the methodology used.

Life stress and Bipolar Disorder: regarding a clinical case

IntroductionResearch on life stress in bipolar disorder largely fails to account for the possibility of a dynamic relationship between psychosocial stress and episode initiation. The kindling hypothesis states that over the course of recurrent affective disorders, there is a weakening temporal relationship between major life stress and episode initiation that could reflect either a progressive sensitization or progressive autonomy to life stress.ObjectivesTo explore the concept of the Kindling model applied to bipolar disorder and to present a clinical case of a bipolar patient whose latter mood episodes were caused by adverse life events.MethodsWe performed a non-systematic literature review using the most relevant papers found on the database PubMed with the keywords “kindling effect”, “allostatic load”, “bipolar disorder” and “prevention”. Description of the clinical case report.ResultsThe phenomenon of kindling was first discovered by Goddard in 1967 who described it in epilepsy. Later, Post applied it to the bipolar disorder, arguing that the initial episodes of both unipolar and bipolar affective disorders are often precipitated by psychosocial stressors, but after multiple recurrences, not only do precipitated episodes continue to occur, but so do spontaneous ones as well. We present the case report of a 62 years old woman, divorced, diagnosed with type 1 bipolar disorder since she was 20 years old. She always have had poor adherence to her medication and follow-up with Psychiatry consultation, with a non-containing sociofamily environment that does not promote clinical stability. Over the time, her admissions on the Psychiatry ward were more frequent and precipitated by adverse life events, mainly caused by the deteriorated relationship with her children.ConclusionsThe kindling model clarifies aspects of the longitudinal course of episode development, recurrence, and progression to spontaneity, as well as further conceptual and theoretical rationales for intervention in order to prevent illness progression.Disclosure of InterestNone Declared

Evaluación en especializaciones médicas: un estudio en una universidad argentina

IntroductionThis paper is part of a research project accredited by official agencies and aims to analyse and describe the new evaluation system implemented in medical specialisations. Material and methodsA qualitative study was carried out by means of interviews with open-ended questions to 35 career directors in 17 medical specialisations, representative of all the training centres in Cordoba, Argentina. Of the 35, 22 correspond to public centres and 13 to private centres. ResultsThe evaluation system is identified as a process that begins at the macro level with the recommendations of the university evaluation and accreditation system and continues in the Secretariat of Graduates in Health Sciences (SGHS - meso) with the implementation of change in the training centres (micro). The interviewees recognise the importance of the SGCS in linking with academic councils and collaborative work, as well as cooperation and socialisation as strategies for resolving difficulties. Principals identify evaluation as a web of relationships between the meso and the micro, and as a formative and continuous fact. They also characterise it as an improvement in learning through feedback from teachers and self-reflection by residents. ConclusionThe new system implemented is identified as an instance of transition between systems, in which the macro, meso and micro and the specific decisions of the evaluation were articulated in a very good process, making possible a necessary articulation in the monitoring and supervision and the progressive autonomy of the student.

POLÍTICA EDUCACIONAL NA REDE ESTADUAL PAULISTA SOB A NOVA GESTÃO PÚBLICA (1995-2018)

ABSTRACT: The article analyses the educational policy of São Paulo State between 1995-2018, period that comprises six mandates of Brazilian Social Democracy Party. The corpus of data was made up of the main programs and projects of each mandate. As a theoretical reference that supported the analysis, the concepts of Gramsci’s integral state and hegemony of the dominant classes’ ideology, and the theory of Punctuated Equilibrium were used. Academic studies on some of the programs and projects were also consulted. It was found that the management paradigm adopted by the Secretary of Education since the first term was that of the New Public Management, in line with the option made by the Fernando Henrique Cardoso government at the federal level, in turn aligned with the international order of capitalist system of production. Among the conclusions of the analysis, the following can be highlighted: the implementation of such a management model has been adjusted, expanded and deepened over the successive mandates; resistance, as this does not happens without tensions, dissidents and internal conflicts, such as difficulties and some defeats imposed by questioning movements; the opposition to the constitutional principle of democratic management of public education and the progressive autonomy of the school as determined by the Law of Directives and Bases of National Education. In summary, this management concept, based on business logic, on centralized formulation and decisions and the vertical delegation of tasks to the school, has not been able to fulfil the promise of improving the quality of education.

Parents v. Government: The Constitutional Challenge Between the Principle of Progressive Autonomy of Children and Parents' Educational Rights in Chile

Parents v. Government: The Constitutional Challenge Between the Principle of Progressive Autonomy of Children and Parents' Educational Rights in Chile

The Attending of the Day ("The Pretending"): An Exercise in Autonomy.

Background As regulations governing appropriate resident supervision increase, it has become increasingly difficult to provide residents with the appropriate level of autonomy during their training years. The "Attending of the Day" describes an experiential teaching method that provides a balance between learners' autonomy and appropriate supervision. Methodology Each day one member of the inpatient team is selected as the "Attending of the Day," or "The Pretending." She or he then performs the typical duties of the teaching faculty, from medical decision-making regarding patient care to educating other team members during rounds. "The Pretending" is directly supervised by the clinical faculty. Results Using the grounded theory methodology, we analyzed 935 anonymous evaluations from students and residents over 14 years, leading to the identification of the following three major themes: created an enabling learning environment, provided autonomy, and improved confidence. These results led to the inclusion of the technique as part of the Back to Bedside initiative, which was rated as an essential tool in building confidence and autonomy by 75% of the participants in the 2018 Accreditation Council for Graduate Medical Education's Back to Bedside residents' well-being survey. Recently, the Jacobs School of Medicine launched the Moments of Excellence in Education: Recognition and Inspiration (MEE:RI) program which gives students a way to recognize exemplary moments of teaching they encounter. The "Attending of the Day" method received recognition as a transformative experience in students' medical education. Conclusions The "Attending of the Day" is the first innovative experiential learning technique that allows learners of all levels in both Undergraduate Medical Education (UME) and Graduate Medical Education (GME) to practice and assess autonomy. This innovation suggests that residents and students are looking for opportunities to challenge themselves. "The Pretending" allows them to experience those challenges in an empowering learning environment while they gradually build their confidence on the path to achieving progressive autonomy.

Principle of progressive autonomy, participation, and recognition of agency. Substantive citizenship in the transition from childhood to adolescence

It is necessary to talk about children's and adolescents' education for citizenship beyond the vindication of spaces for citizen action. It is necessary to incorporate the principle of progressive autonomy highlighted by the Convention on the Rights of the Child of 1989 in terms of 'evolving capacities', from the knowledge of their rights and their exercise. This article aims to analyse the concept of substantive citizenship of children and adolescents based on their right to participation and from the recognition of their agency, as well as the promotion of and respect for the principle of progressive autonomy. Based on a participatory narrative research with a socio-critical perspective, 23 discussion groups were carried out with 210 young people between 15 and 19 years old in five Iberoamerican cities: Barcelona, Buenos Aires, Mexico City, Madrid and Sao Paolo. From the content analysis of their contributions, three dimensions emerge: to know oneself as a subject of rights from the knowledge of these rights, the importance of intergenerational relations in recognising progressive autonomy, and the incidence of age in the development of their autonomy. As conclusions, it should be noted that young people in the five cities know their rights and recognise that family, school and social networks favour their recognition as subjects of rights and responsibilities. It also reveals that age is a limiting element and a fundamental factor for the development of substantive citizenship.

Children’s Participation, Progressive Autonomy, and Agency for Inclusive Education in Schools

Whereas children’s agency and their right to civic participation have been extensively discussed in childhood studies, especially within sociology, their presence in pedagogical studies is still scarce. We intend to contribute to tentatively plugging that gap by analysing the need for a change of perspective in school settings based on acknowledging children as participatory social actors. We are committed to an epistemological broadening of the expression “inclusive education” that complements the traditional and necessary meaning of “reaching to all learners”; a broadening grounded on the configuration of intergenerational relationships in which children participate in schools as learners and partners, as agents who are part of their community and take part in it. Schools are thus transformed into inclusive democratic educational communities or fellowships that include children in the decision‐making on those aspects that affect them, according to their progressive autonomy, while validating their knowledge and experiences. The article is framed on the sustainable development goals (SDG), specifically on SDG no.4, to ensure inclusive, equitable, and quality education, and SDG no.16, which urges to promote just, peaceful, and inclusive societies and the consolidation of institutions. Our stance is that a significant step forward to achieving these goals is that schools should prepare for life in democracy by being experienced and run democratically. This involves children’s gradual participation in school management, from the micro to the macro level. To this end, we focus on three key elements: children’s rights to participation, the principle of progressive autonomy, and acknowledging children’s agency in schools.

Bases conceptuales de las actividades profesionales a confiar para la educación de profesionales de la salud en Latinoamérica

The concept of entrustable professional activities emerged as an attempt to overcome some of the criticisms to the competency-based medical education approach; it has had a broad impact in practice and health professions education research. It has been disseminated internationally with its English acronym: EPA. This approach proposes to orient assessment and teaching to specific activities in the profession, which allows the integration of several competencies, and to determine which responsibilities can be entrusted to the trainee, in a gradual and explicit manner. The model assumes the definition of levels of supervision that allow progressive autonomy for each EPA, in students or residents, once they demonstrate the required competencies. Practice, supervision and feedback in real clinical scenarios are key to the development of autonomy in EPA performance. The dissemination of the EPA approach is still limited in Latin America, but it has the potential to create a significant contribution to curriculum design and evaluation, and to assessment practices of health professionals across their careers. It provides a deep review of the assumptions under which healthcare professional practice decisions are made, at under and postgraduate levels.

Informal Caregiving in Amyotrophic Lateral Sclerosis (ALS): A High Caregiver Burden and Drastic Consequences on Caregivers' Lives.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that causes progressive autonomy loss and need for care. This does not only affect patients themselves, but also the patients’ informal caregivers (CGs) in their health, personal and professional lives. The big efforts of this multi-center study were not only to evaluate the caregivers’ burden and to identify its predictors, but it also should provide a specific understanding of the needs of ALS patients’ CGs and fill the gap of knowledge on their personal and work lives. Using standardized questionnaires, primary data from patients and their main informal CGs (n = 249) were collected. Patients’ functional status and disease severity were evaluated using the Barthel Index, the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) and the King’s Stages for ALS. The caregivers’ burden was recorded by the Zarit Burden Interview (ZBI). Comorbid anxiety and depression of caregivers were assessed by the Hospital Anxiety and Depression Scale. Additionally, the EuroQol Five Dimension Five Level Scale evaluated their health-related quality of life. The caregivers’ burden was high (mean ZBI = 26/88, 0 = no burden, ≥24 = highly burdened) and correlated with patients’ functional status (rp = −0.555, p < 0.001, n = 242). It was influenced by the CGs’ own mental health issues due to caregiving (+11.36, 95% CI [6.84; 15.87], p < 0.001), patients’ wheelchair dependency (+9.30, 95% CI [5.94; 12.66], p < 0.001) and was interrelated with the CGs’ depression (rp = 0.627, p < 0.001, n = 234), anxiety (rp = 0.550, p < 0.001, n = 234), and poorer physical condition (rp = −0.362, p < 0.001, n = 237). Moreover, female CGs showed symptoms of anxiety more often, which also correlated with the patients’ impairment in daily routine (rs = −0.280, p < 0.001, n = 169). As increasing disease severity, along with decreasing autonomy, was the main predictor of caregiver burden and showed to create relevant (negative) implications on CGs’ lives, patient care and supportive therapies should address this issue. Moreover, in order to preserve the mental and physical health of the CGs, new concepts of care have to focus on both, on not only patients but also their CGs and gender-associated specific issues. As caregiving in ALS also significantly influences the socioeconomic status by restrictions in CGs’ work lives and income, and the main reported needs being lack of psychological support and a high bureaucracy, the situation of CGs needs more attention. Apart from their own multi-disciplinary medical and psychological care, more support in care and patient management issues is required.

LOS ESPACIOS OLVIDADOS DE PARTICIPACIÓN Y AUTONOMÍA ESCOLAR FRENTE A LOS PROCESOS DE RENDICIÓN DE CUENTAS Y BUROCRACIA EN MÉXICO

Este articulo reflexiona en la disyuntiva que presentan los discursos internacionales sobre una renovación educativa que apuesta por conceder autonomía a las escuelas como centros neurálgicos en donde se desarrollan los verdaderos espacios de acción pedagógica, en contraposición con las exigencias por la obtención de resultados exitosos en exámenes, comparativas globales y rendición de cuentas. Es en este reto contradictorio, agobiante e inoperante de la educación donde pretendemos centrar este análisis que abordamos con una mirada positiva a la autonomía progresista y su lucha por adaptarse a las particularidades y necesidades del contexto social y cultural de las escuelas, bajo el influjo de un contexto burocrático. En el caso de México, enfrentándose a dos retos importantes, deshacerse de estructuras burocráticas y a su vez responder a las exigencias de transparencia y rendición de cuentas que obstaculizan las iniciativas pedagógicas y de participación de la gestión escolar bajo procesos evaluativos con requerimientos inquisitivos diseñados y programados desde la cúpula central. No obstante, existe un inagotable esfuerzo por avanzar en el desafío de reestablecer los espacios y canales de participación democrática y colaborativa, en donde nuevamente se puedan enlazar los propósitos educativos con las aspiraciones, metas y vida cotidiana de la comunidad escolar.

Trainee Autonomy in Minimally Invasive General Surgery in the United States: Establishing a National Benchmark

Minimally invasive surgery (MIS) is an integral component of General Surgery training and practice. Yet, little is known about how much autonomy General Surgery residents achieve in MIS procedures, and whether that amount is sufficient. This study aims to establish a contemporary benchmark for trainee autonomy in MIS procedures. We hypothesize that trainees achieve progressive autonomy, but fail to achieve meaningful autonomy in a substantial percentage of MIS procedures prior to graduation. Fifty General Surgery residency programs in the United States, from September 1, 2015 to March 19, 2020. All Categorical General Surgery Residents and Attending Surgeons within these programs were eligible. Data were collected prospectively from attending surgeons and categorical General Surgery residents. Trainee autonomy was assessed using the 4-level Zwisch scale (Show and Tell, Active Help, Passive Help, and Supervision Only) on a smartphone application (SIMPL). MIS procedures included all laparoscopic, thoracoscopic, endoscopic, and endovascular/percutaneous procedures performed by residents during the study. Primary outcomes of interest were "meaningful autonomy" rates (i.e., scores in the top 2 categories of the Zwisch scale) by postgraduate year (PGY), and "progressive autonomy" (i.e., differences in autonomy between PGYs) in MIS procedures, as rated by attending surgeons. Primary outcomes were determined with descriptive statistics, one-way analysis of variance (ANOVA) and Z-tests. Secondary analyses compared (i) progressive autonomy between common MIS procedures, and (ii) progressive autonomy in MIS vs. non-MIS procedures. A total of 106,054 evaluations were performed across 50 General Surgery residency programs, of which 38,985 (37%) were for MIS procedures. Attendings performed 44,842 (42%) of all evaluations, including 16,840 (43%) of MIS evaluations, while residents performed the rest. Overall, meaningful autonomy in MIS procedures increased from 14.1% (PGY1s) to 75.9% (PGY5s), with significant (p < 0.001) increases between each PGY level. Meaningful autonomy rates were higher in the MIS vs. non-MIS group [57.2% vs. 48.0%, p < 0.001], and progressed more rapidly in MIS vs. non-MIS, (p < 0.05). The 7 most common MIS procedures accounted for 83.5% (n = 14,058) of all MIS evaluations. Among PGY5s performing these procedures, meaningful autonomy rates (%) were: laparoscopic appendectomy (95%); laparoscopic cholecystectomy (93%); diagnostic laparoscopy (87%); upper/lower endoscopy (85%); laparoscopic hernia repair (72%); laparoscopic partial colectomy (58%); and laparoscopic sleeve gastrectomy (45%). US General Surgery residents receive progressive autonomy in MIS procedures, and appear to progress more rapidly in MIS versus non-MIS procedures. However, residents fail to achieve meaningful autonomy in nearly 25% of MIS cases in their final year of residency, with higher rates of meaningful autonomy only achieved in a small subset of basic MIS procedures.