Study reveals trends in autonomy throughout clinical training - Children's National

Promoting autonomy while also providing the appropriate supervision to fellows throughout clinical training can be a hard balance to strike.

In a longitudinal study published in Academic Pediatrics, researchers at Children's National followed a group of fellows over the course of three years, interviewing them every six months. The study sought to answer the question: "How do trainees conceptualize and enact autonomy through training and into clinical practice as attendings?"

"As medical educators, we all want to provide a strong experience for our trainees, and this requires faculty who are knowledgeable and empowered to help train them," Valerie Jurgens, MD, hospitalist and lead author of the study, said. "This work is meant to understand how trainees evolve, so that faculty can effectively meet them where they are."

The big picture

In July 2021, researchers recruited 14 first-year pediatric hospital medicine fellows and followed them throughout the next three years. Interview transcripts collected every six months were coded through an iterative process, allowing researchers to identify themes and patterns across participants' experiences over time.

A key finding was a shift in how participants understood autonomy. During fellowship or after transitioning to attending roles, many moved from viewing autonomy as closely tied to independence to a more dynamic, collaborative model.

As new attendings, many struggled to grant trainees the same independence they had valued during fellowship. Because independence and autonomy had become closely linked in their thinking, they often viewed autonomy as conditional upon a trainee demonstrating readiness.

The hold up in the field

There is limited research on how physicians' understanding and enactment of autonomy evolves throughout training and into unsupervised practice.

Understanding how perceptions of autonomy change over the course of clinical training may help align trainee-supervisor expectations and support more intentional approaches to fostering autonomy across the training continuum.

Additional Children's National contributors included Priti Bhansali, MD, and Neha Shah MD, MPH.

Read the full study, "Evolving Conceptualizations of Autonomy: A Longitudinal Study of Pediatric Hospital Medicine Fellows into Attending Practice," in Academic Pediatrics.