The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy. Hosp Pediatr 2023 Jun 01;13(6):490-503
Date
05/08/2023Pubmed ID
37153964DOI
10.1542/hpeds.2022-006827Scopus ID
2-s2.0-85179615400 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVES: Autonomy is necessary for resident professional development and well-being. A recent focus on patient safety has increased supervision and decreased trainee autonomy. Few validated interventions exist to improve resident autonomy. We aimed to use quality improvement methods to increase our autonomy metric, the Resident Autonomy Score (RAS), by 25% within 1 year and sustain for 6 months.
METHODS: We developed a bundled-intervention approach to improve senior resident (SR) perception of autonomy on Pediatric Hospital Medicine (PHM) services at 5 academic children's hospitals. We surveyed SR and PHM faculty perceptions of autonomy and targeted interventions toward areas with the highest discordance. Interventions included SR and faculty development, expectation-setting huddles, and SR independent rounding. We developed a Resident Autonomy Score (RAS) index to track SR perceptions over time.
RESULTS: Forty-six percent of SRs and 59% of PHM faculty completed the needs assessment survey querying how often SRs were afforded opportunities to provide autonomous medical care. Faculty and SR ratings were discordant in these domains: SR input in medical decisions, SR autonomous decision-making in straightforward cases, follow-through on SR plans, faculty feedback, SR as team leader, and level of attending oversight. The RAS increased by 19% (3.67 to 4.36) 1 month after SR and faculty professional development and before expectation-setting and independent rounding. This increase was sustained throughout the 18-month study period.
CONCLUSIONS: SRs and faculty perceive discordant levels of SR autonomy. We created an adaptable autonomy toolbox that led to sustained improvement in perception of SR autonomy.
Author List
Allen K, Najjar M, Ostermeier A, Washington N, Genies MC, Hazle M, Hardy C, Lewis K, McDaniel L, McFarlane DJ, Macias C, Molloy MJ, Perry MF, Piper L, Sevov C, Titus L, Toth H, Unaka NI, Weisgerber MC, Kasick RAuthors
Lauren Titus MD Assistant Professor in the Pediatrics department at Medical College of WisconsinHeather Toth MD Professor in the Medicine department at Medical College of Wisconsin
Michael C. Weisgerber MD Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
ChildClinical Competence
Faculty, Medical
General Surgery
Humans
Internship and Residency
Professional Autonomy
Surveys and Questionnaires
