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Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help
Eric A Biondi1, William S Varade, Lynn C Garfunkel
1Dr. Biondi is assistant professor, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr. Varade is associate professor and residency program director, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr. Garfunkel is associate professor and associate program director, Pediatric Residency Program and Medicine-Pediatric Residency Program, Department of Pediatrics, University of Rochester School of Medicine and Dentistry and Rochester General Hospital, Rochester, New York. Dr. Lynn is assistant professor, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr. Craig is associate program director, Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington. At the time of the study, he was a general pediatrics fellow, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York. Dr. Cellini is attending clinician, Department of Pediatrics, Bronx-Lebanon Hospital Center, and assistant professor, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York. At the time of the study, she was a general pediatrics fellow, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York. Dr. Shone is director, Division of Primary Care Research, Department of Research, American Academy of Pediatrics, Chicago, Illinois. At the time of the study, she was associate professor of pediatrics and clinical nursing, Center for Community Health, University of Rochester Medical Center, Rochester, New York. Dr. Harris is professor emeritus, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr. Baldwin is professor, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
Purpose:
To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy.
Method:
Parallel questionnaires were sent to pediatric residents and faculty at the University of Rochester Medical Center in 2011. Items addressed self-determination theory (SDT) constructs (autonomy, competence, relatedness) and asked residents and faculty to rate and/or comment on their own and the other group's behaviors. Distributions of responses to 17 parallel Likert scale items were compared by Wilcoxon rank-sum tests. Written comments underwent qualitative content analysis.
Results:
Respondents included 62/78 residents (79%) and 71/100 faculty (71%). The groups differed significantly on 15 of 17 parallel items but agreed that faculty sometimes provided too much direction. Written comments suggested that SDT constructs were closely interrelated in residency training. Residents expressed frustration that their care plans were changed without explanation. Faculty reported reluctance to give "passive" residents autonomy in patient care unless stakes were low. Many reported granting more independence to residents who displayed motivation and competence. Some described working to overcome residents' passivity by clarifying and reinforcing expectations.
Conclusions:
Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of "passive" residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.
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