The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy.

Area of Science:

• Medical Education
• Quality Improvement
• Patient Safety

Background:

• Resident autonomy is vital for professional development and well-being.
• Increased patient safety focus has led to heightened supervision and reduced trainee autonomy.
• Validated interventions to enhance resident autonomy are scarce.

Purpose of the Study:

• To implement quality improvement methods to increase the Resident Autonomy Score (RAS) by 25% within one year.
• To sustain the increase in RAS for six months.
• To address the discordance in perceptions of autonomy between senior residents (SRs) and faculty.

Main Methods:

• A bundled-intervention approach was used to improve SR perception of autonomy in Pediatric Hospital Medicine (PHM).
• Surveys assessed SR and PHM faculty perceptions, targeting interventions toward areas with the most significant discordance.
• Interventions included faculty and SR development, expectation-setting huddles, and SR independent rounding.

Main Results:

• The Resident Autonomy Score (RAS) increased by 19% (from 3.67 to 4.36) within one month of initial interventions.
• This improvement was sustained over the 18-month study period.
• Significant discordance was noted between SR and faculty perceptions regarding autonomous medical care opportunities.

Conclusions:

• A significant gap exists in perceived autonomy between senior residents and faculty.
• An adaptable "autonomy toolbox" was developed, leading to sustained improvements in the perception of resident autonomy.
• The study highlights the effectiveness of quality improvement methods in enhancing resident autonomy.