Promoting Autonomy in Pediatric Trainees: Independent Rounding on a Pediatric Hospital Medicine Service

Trainee autonomy is a value emphasized by formal governing bodies within graduate medical education, yet prior data demonstrate that pediatric residents perceive less autonomy than attendings report providing. Independent rounding (IR) is one practice that has been demonstrated in qualitative studies to promote autonomy. The objective of our study was to promote graduated trainee autonomy and to understand the interprofessional perspectives on the implementation of IR across various domains.

A single-center mixed-methods study was conducted between July 2021 and June 2022 at a quaternary children's hospital. IR was introduced on one inpatient team 1 day/week for the academic year. Postsurveys were sent to participants that included resident trainees, medical students, attendings, and nurses comparing IR with traditional rounding.

Attendings and trainees who rotated on one of the inpatient pediatrics teams were automatically enrolled in this study, which included 26 medical students, 41 interns, 22 senior residents, and 15 attending physicians. IR was well received among all participants. All senior residents reported improved perceptions of autonomy. There was overall improved or lack of change in perceptions of patient safety, teaching and feedback, and clinical workflow. All attendings and trainees endorsed that residents should have the opportunity to round independently, with trainees feeling that the opportunity should be more frequent than once per week.

IR is a feasible and well-received method of promoting graduated trainee autonomy.