Pediatric Grand Rounds (CME): Righting the Pendulum: Promoting Trainee Autonomy

According to the American College of Graduate Medical Education (ACGME), “a residency training program must foster in residents the skills, knowledge, and attitudes required to enter the unsupervised practice of medicine. [...] As residents gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with greater independence. This concept -- graded and progressive responsibility -- is one of the core tenets of American graduate medical education.” During the late 1980s, the balance of trainee autonomy and supervision received national attention in the wake of the burgeoning national patient safety movement, resulting in mandated restrictions on resident duty hours and provisions of increased supervision for physicians in training. It is within the confines of this system, medical educators of today are tasked with the responsibility of developing the physicians of tomorrow.

This interactive session will begin with a modified group force field analysis to highlight the facilitating factors and barriers to promoting trainee autonomy. It will review the history of trainee autonomy and key principles of autonomy, as described in self-determination theory and entrustment decision-making. The session will conclude with a discussion of individual and systems strategies that can be implemented to promote trainee autonomy, highlighting the scholarly work of the 2018-2019 Stanford Pediatric Chief Residents.

• Identify facilitating factors and barriers to promoting trainee autonomy across clinical settings
• Describe the history of trainee autonomy and key principles of autonomy, as described in self-determination theory and entrustment decision-making
• Discuss individual and systems strategies that can be implemented to promote trainee autonomy