Trainee Autonomy is Associated with Well-Being

Progressive entrustment is critical to reaching independent practice. Concerns around progressive entrustment during clinical training have grown in the past decade, particularly with the evolution of the vascular surgery training pipeline. The purpose of this study is to evaluate vascular surgery trainee perceptions of autonomy and its associations with their well-being and learning environment.

Data were collected through a confidential, voluntary survey administered after the 2020-2024 Vascular Surgery In-Training Exams as an adjunct to the vascular arm of the Surgical Education Culture Optimization through targeted interventions based on National comparative Data trial. Autonomy was defined by operative autonomy, clinical autonomy, and operative time. Trainees ranked their degree of satisfaction with each component on a Likert scale, which was subsequently dichotomized. Univariable logistic regression was used to evaluate the association between autonomy and well-being outcomes. Multivariable logistic regression was used to evaluate learning environment factors associated with trainee dissatisfaction with autonomy.

A total of 3,272 survey results were collected from 2020 to 2024. Approximately 3.9% (n = 117) of survey responses reported dissatisfaction with operative autonomy, 2.0% (n = 52) of responses reported dissatisfaction with clinical autonomy, and 4.2% (n = 93) of responses reported dissatisfaction with the amount of time spent in the operating room. These rates remained unchanged over time (P > 0.05). Within 2024 responses, the only statistically significant difference in demographic variables between trainees who were dissatisfied with autonomy and those who were satisfied was gender (dissatisfaction: 12% females versus 5% males, P = 0.016). In comparison, all learning environment factors were statistically significantly different between groups (P < 0.001). On adjusted analysis, dissatisfaction with autonomy was driven by trainee perceptions of faculty engagement (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 1.9-12.0, P < 0.001) and efficiency and program resources (aOR 10.9, 95% CI 4.4-26.8, P < 0.001). Perceptions of autonomy also had significant associations with well-being metrics. Trainees who reported dissatisfaction with their autonomy were also more likely to report burnout, thoughts of attrition, suicidal ideation, professional dissatisfaction, and personal dissatisfaction.

A minority of vascular trainees expressed dissatisfaction with their autonomy. Those who experienced this dissatisfaction had higher odds of adverse training experiences, including burnout, work-life conflict, thoughts of attrition, and suicidal ideation. Program monitoring of trainee autonomy and operative time may mitigate this risk.