How do attendings perceive housestaff autonomy? Attending experience, hospitalists, and trends over time

Graduated supervision is necessary for residents to progress to independence, but it is unclear what factors influence attendings' perception of housestaff autonomy.

To determine if attending characteristics and secular trends are associated with variation in attendings' perception of housestaff autonomy.

Secondary data analysis of monthly survey data collected from 2001 to 2008.

Attending hospitalists and nonhospitalists on teaching internal medicine services at an academic tertiary care center.

Attendings' perception of intern decision making and resident autonomy.

Response rate was 70% (514/738). Compared with early-career attendings, experienced attendings perceived more intern involvement in decision making (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.17-3.97, P=0.013). Hospitalists perceived less intern involvement in decision making (OR: 0.19, 95% CI: 0.06-0.58, P=0.004) and resident autonomy (OR: 0.27, 95% CI: 0.11-0.66, P=0.004) compared with nonhospitalists. A significant interaction existed between hospitalists and experience; experienced hospitalists perceived more intern decision making (OR: 7.36, 95% CI: 1.86-29.1, P=0.004) and resident autonomy (OR: 5.85, 95% CI: 1.75-19.6, P=0.004) compared with early-career hospitalists. With respect to secular trends, spring season of the academic year was associated with greater perception of intern decision making compared with other seasons (OR: 1.94, 95% CI: 1.18-3.19, P=0.009). The 2003 resident duty-hours restrictions were associated with decreased perception of intern decision making (OR: 0.51, 95% CI: 0.29-0.87, P=0.014) and resident autonomy (OR: 0.49, 95% CI: 0.28-0.86, P=0.012).

Perception of housestaff autonomy varies with attending characteristics and time trends. Hospitalists perceive autonomy and clinical decision making differently, depending on their attending experience.