Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and...

Area of Science:

• Medical Education
• Healthcare Management
• Patient Safety

Background:

• The balance between resident autonomy and attending supervision is crucial for trainee development and patient safety.
• Tensions arise in modern clinical learning environments when this balance is compromised.
• This study investigates current and ideal states of autonomy and supervision, identifying factors contributing to imbalance.

Approach:

• A mixed-methods study utilized surveys and focus groups with medical trainees and attending physicians across three hospitals.
• Quantitative survey data were analyzed using chi-square and Fisher's exact tests.
• Qualitative thematic analysis was applied to open-ended survey responses and focus group discussions.

Key Points:

• Trainees perceived greater current autonomy than attendings, though both groups idealize a more autonomous environment.
• Five key factors influencing the autonomy-supervision balance were identified: attending, trainee, patient, interpersonal, and institutional.
• These factors are dynamic, interactive, and influenced by cultural shifts towards increased hospitalist supervision and emphasis on patient safety.

Conclusions:

• Both trainees and attendings agree that the clinical learning environment should prioritize resident autonomy.
• The current environment does not achieve the ideal balance between autonomy and supervision.
• Complex, multifaceted factors and evolving cultural dynamics impact trainee autonomy in medical residency.