Perceptions of Resident Autonomy and Decision-Making Opportunities on Pediatric Hospital Medicine Teams

TL;DR

This study explores how much autonomy resident physicians have in making medical decisions on pediatric hospital teams and compares perceptions between residents and attending physicians.

Contribution

The study provides new insights into perceived resident autonomy in pediatric training, highlighting discrepancies in antimicrobial choice and patient/family communication.

Findings

There was general agreement between residents and attendings on autonomy levels for most decisions.

Residents and attendings differed significantly in perceptions of autonomy for antimicrobial choice.

Discrepancies were also found in addressing patient and family concerns.

Abstract

Providing autonomy to resident physicians is critical to their professional development. However, opportunities to foster entrustment, and thereby resident-led medical decision making, are often limited in pediatric training. We sought to examine attending physicians' and residents' perceptions of resident autonomy on inpatient pediatric wards with regard to specific medical decisions and patient-care tasks. We conducted a cross-sectional study of pediatric residents and attendings at five academic medical centers in the United States (US): Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Nationwide Children’s Hospital, Columbus, OH; Children's Hospital of Philadelphia, Philadelphia, PA; Johns Hopkins Children’s Center, Baltimore, MD; and Children’s Wisconsin, Milwaukee, WI. Respondents completed an eight-item survey that rated the percentage of time residents were given autonomy for specific medical decisions. We performed descriptive statistical analysis to compare responses between the groups. Overall, we identified general concordance between attending and resident ratings of autonomy. There were statistically significant differences between resident and attending responses pertaining to antimicrobial choice and addressing patient/family concerns.

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