Trainee Autonomy and Supervision in the Inpatient Clinical Learning Environment.

Area of Science:

• Medical Education
• Clinical Supervision
• Patient Safety

Background:

• Balancing resident autonomy and supervision is vital for trainee development and patient safety in complex inpatient settings.
• Imbalances in this dynamic can create tension within the clinical learning environment.

Purpose of the Study:

• To understand current and ideal states of autonomy and supervision in medical residency.
• To identify factors contributing to autonomy-supervision imbalance from trainee and attending perspectives.

Main Methods:

• Sequential mixed-methods design utilizing surveys and focus groups with residents and attendings.
• Data collected from May 2019 to June 2020 across three hospitals.
• Statistical comparison of survey responses and thematic analysis of qualitative data.

Main Results:

• Trainees perceived higher current autonomy than attendings; both groups desired greater autonomy.
• Five core contributors to the autonomy-supervision balance identified: attending, trainee, patient, interpersonal, and institutional factors.
• These factors are complex, interactive, and require continuous adjustment.

Conclusions:

• Consensus exists that resident autonomy should be more prioritized.
• A complex interplay of individual, interpersonal, and institutional factors impacts autonomy-supervision dynamics.
• Understanding these interactions is critical for optimizing the inpatient clinical learning environment.