Stephanie DeLeon
The University of Oklahoma Health Sciences Center
Background: In the current medical learning environment focused on patient safety, the achievement of resident autonomy has become more challenging. Though several studies have looked at various aspects of resident autonomy, none yet has focused on identifying the process by which residents perceive they achieve autonomy.
Aims: The aim of this study was to identify the process pediatric residents describe as they achieve autonomy throughout residency.
Methods: This qualitative study was conducted via individual semi-structured interviews with third year pediatric residents nearing graduation at a large academic children’s hospital. Interview transcripts were coded and themed using Grounded Theory methodology.
Results: Nine graduating residents completed interviews. Residents described eight stages and influencing factors on the path to achieving autonomy: intern anxiety and fear, developing an internal drive for autonomy, necessary discomfort in decision making, faculty support through intentional opportunities for autonomy and the creation of a safe learning environment, faculty detraction from autonomy secondary to lack of opportunity, feeling the freedom to make decisions, and finally, practicing autonomy before graduation.
Conclusions: Residents were able to identify a series of internal steps moved through during their development of autonomy; several external faculty and environment factors were also identified. These results suggest modifiable behaviors and learning cultures that can be developed to promote the achievement of resident autonomy.
