"Always over their shoulder": Educator and resident perceptions of supervision and autonomy in pediatric surgery...

Surgical residents on pediatric surgery rotations often have difficulty adjusting to decreased levels of autonomy. This study explores the reasons for and educational implications of this phenomenon. We performed 28 interviews with surgical residents and pediatric surgery attendings, fellows, and advanced practice providers from 16 institutions across the country and performed thematic analysis. Three themes emerged. First, perceptions of low autonomy are due to a high degree of supervision, which exists to ensure patient safety. Second, the need for increased supervision arises from numerous patient, surgeon, and resident factors specific to the pediatric surgical context. Third, educators and learners identified best practices to promote autonomy while maintaining safety. A shared understanding among surgical educators and learners about the factors which play into complex autonomy decisions and a common strategy to capitalize on appropriate learning opportunities may optimize resident training, both in pediatric surgery and other operative settings.