Council on Medical Student Education in Pediatrics


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Entrustable is in the Eye of the Beholder

Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide? Biondi EA et al. Academic Medicine 2015 Vol. 90, No. 4

Reviewed by Molly Rideout

What was the study question?
Do pediatric residents and faculty at the University of Rochester perceive resident autonomy and faculty support of resident autonomy differently?

How was the study done?
Authors developed parallel questionnaires for residents and faculty to address the principles of autonomy, competence, and relatedness, the basis for self-determination theory (SDT). Participants completed an 11-question Likert-style survey with optional written comments. Researchers performed qualitative and quantitative analysis of the results.

What were the results?
62 residents and 71 faculty members completed the surveys. Residents scored themselves higher in all areas than faculty members scored them (higher self-perceived competence); likewise faculty members scored themselves higher in most areas than residents scored them (higher self-perceived encouragement of autonomy). Both groups agree that faculty members provide too much direction. Analysis of comments showed that certain faculty members have successfully approached the issue of "passive" residents by granting increasing levels of autonomy, allowing for the resident to demonstrate competence in certain areas prior to increasing levels of autonomy (scaffolding).

What are the implications of these findings?
Resident autonomy is a common area of conflict between residents and faculty members, and the ideas behind Self-Determination Theory could be used in varied settings with different levels of learners and teachers to address this issue. SDT theory is applicable to medical students as well, and scaffolding could be used as a framework with all levels of students. As reflected in the comments, residents feel supported when faculty ask for their input instead of telling them the plan.

Editor's note: A nice validation of the Milestones Project—something just beginning to percolate into undergraduate medical education. What's not discussed in the article is the influence of the medico-legal climate on autonomy, both for students and residents. (JG)

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