Using self-determination theory to improve residency training: learning to make omelets without breaking eggs.

Area of Science:

• Medical Education
• Clinical Training
• Patient Safety

Background:

• An inherent tension exists in clinical training between supervising learners for quality and patient safety, and allowing independent practice for experience.
• Faculty and resident perceptions of autonomous practice for housestaff reveal a disconnect, with each group viewing itself as more competent.
• Self-determination theory (SDT) provides a framework for understanding intrinsic motivation, autonomy, competence, and relatedness in learning.

Discussion:

• Faculty desire evidence of internal motivation, competence, and self-confidence from residents to entrust them with autonomy.
• Faculty perceive a lack of these desired qualities in many residents, complicating the balance between supervision and autonomy.
• Applying an SDT framework to the findings highlights the need to foster these attributes in learners.

Key Insights:

• A significant disconnect exists between faculty and resident perceptions regarding autonomous practice and competence.
• Faculty seek specific indicators of readiness for autonomy, which they feel are often unmet by residents.
• Self-determination theory offers valuable insights into the motivational factors influencing learner development and entrustment.

Outlook:

• The proposed use of
• scaffolding,
• a construct from developmental psychology, can support learner development and progression to greater entrustment and competence.
• Optimizing the balance between autonomy and supervision is crucial for ensuring high-quality patient care during training and for the future.
• Medical educators must transform learning processes to safely and effectively foster learner autonomy and competence.