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Progressive independence in clinical training: a tradition worth defending?
Tara J T Kennedy1, Glenn Regehr, G Ross Baker
1Wilson Centre for Research in Education at the University Health Network, 200 Elizabeth Street, Eaton South 1-565, Toronto, Ontario, Canada M5G 2C4. tara.kennedy@utoronto.ca
Summary
Progressive independence in clinical training is traditional but facing challenges. Limited evidence supports its efficacy, yet theory suggests reducing trainee autonomy may harm long-term learning.
Area of Science:
- Medical Education
- Psychology
- Sociology
Background:
- Progressive independence is a cornerstone of clinical training.
- Current healthcare trends like managed care and patient safety impact trainee autonomy.
- This review examines evidence and theory on progressive autonomy in clinical learning.
Purpose of the Study:
- To review empirical evidence and theoretical perspectives on progressive autonomy in clinical learning.
- To assess the impact of current healthcare trends on trainee independence.
- To identify areas for future research.
Main Methods:
- Computerized literature search of Medline, PsycINFO, SSCI, and ERIC.
- Synthetic review of empirical and theoretical concepts.
- Integration of insights from medicine, psychology, education, kinesiology, and sociology.
Main Results:
- Clinical psychology and medical education literature show increasing trainee independence but lack efficacy data.
- Expertise and motor learning theories suggest excessive guidance can be detrimental.
- Sociology offers insights into cultural values influencing supervision and independence.
Conclusions:
- Empirical support for the current progressive independence model is limited.
- Theoretical concerns exist regarding the erosion of trainee autonomy.
- Future research should address social and economic impacts on clinical education.