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Conner SM, Choi N, Fuller J, Daya S, Barish P, Rennke S, Harrison JD, Narayana S. Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives. RESEARCH SQUARE 2023:rs.3.rs-2982838. [PMID: 37333324 PMCID: PMC10275050 DOI: 10.21203/rs.3.rs-2982838/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the modern clinical learning environment, tension exists when this balance is skewed. This study aimed to understand the current and ideal states of autonomy and supervision, then describe the factors that contribute to imbalance from both trainee and attending perspectives. Methods A mixed-methods design included surveys and focus groups of trainees and attendings at three institutionally affiliated hospitals between May 2019-June 2020. Survey responses were compared using chi-square tests or Fisher's exact tests. Open-ended survey and focus group questions were analyzed using thematic analysis. Results Surveys were sent to 182 trainees and 208 attendings; 76 trainees (42%) and 101 attendings (49%) completed the survey. Fourteen trainees (8%) and 32 attendings (32%) participated in focus groups. Trainees perceived the current culture to be significantly more autonomous than attendings; both groups described an "ideal" culture as more autonomous than the current state. Focus group analysis revealed five core contributors to the balance of autonomy and supervision: attending-, trainee-, patient-, interpersonal-, and institutional-related factors. These factors were found to be dynamic and interactive with each other. Additionally, we identified a cultural shift in how the modern inpatient environment is impacted by increased hospitalist attending supervision and emphasis on patient safety and health system improvement initiatives. Conclusions Trainees and attendings agree that the clinical learning environment should favor resident autonomy and that the current environment does not achieve the ideal balance. There are several factors contributing to autonomy and supervision, including attending-, resident-, patient-, interpersonal-, and institutional-related. These factors are complex, multifaceted, and dynamic. Cultural shifts towards supervision by primarily hospitalist attendings and increased attending accountability for patient safety and systems improvement outcomes further impacts trainee autonomy.
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Allen K, Najjar M, Ostermeier A, Washington N, Genies MC, Hazle M, Hardy C, Lewis K, McDaniel L, McFarlane DJ, Macias C, Molloy MJ, Perry MF, Piper L, Sevov C, Titus L, Toth H, Unaka NI, Weisgerber MC, Kasick R. The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy. Hosp Pediatr 2023; 13:490-503. [PMID: 37153964 DOI: 10.1542/hpeds.2022-006827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Autonomy is necessary for resident professional development and well-being. A recent focus on patient safety has increased supervision and decreased trainee autonomy. Few validated interventions exist to improve resident autonomy. We aimed to use quality improvement methods to increase our autonomy metric, the Resident Autonomy Score (RAS), by 25% within 1 year and sustain for 6 months. METHODS We developed a bundled-intervention approach to improve senior resident (SR) perception of autonomy on Pediatric Hospital Medicine (PHM) services at 5 academic children's hospitals. We surveyed SR and PHM faculty perceptions of autonomy and targeted interventions toward areas with the highest discordance. Interventions included SR and faculty development, expectation-setting huddles, and SR independent rounding. We developed a Resident Autonomy Score (RAS) index to track SR perceptions over time. RESULTS Forty-six percent of SRs and 59% of PHM faculty completed the needs assessment survey querying how often SRs were afforded opportunities to provide autonomous medical care. Faculty and SR ratings were discordant in these domains: SR input in medical decisions, SR autonomous decision-making in straightforward cases, follow-through on SR plans, faculty feedback, SR as team leader, and level of attending oversight. The RAS increased by 19% (3.67 to 4.36) 1 month after SR and faculty professional development and before expectation-setting and independent rounding. This increase was sustained throughout the 18-month study period. CONCLUSIONS SRs and faculty perceive discordant levels of SR autonomy. We created an adaptable autonomy toolbox that led to sustained improvement in perception of SR autonomy.
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Affiliation(s)
- Karen Allen
- Division of Hospital Medicine, Department of Pediatrics
| | | | - Austen Ostermeier
- Division of Hospital Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Nicole Washington
- Section of Hospital Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marquita C Genies
- Division of Hospital Medicine, Department of Pediatrics, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Hazle
- Division of Hospital Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | - Kristen Lewis
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lauren McDaniel
- Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Daniel J McFarlane
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charlie Macias
- Planning and Business Development, Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew J Molloy
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laura Piper
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Claire Sevov
- Division of Hospital Medicine, Department of Pediatrics
- Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Lauren Titus
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
| | - Heather Toth
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
- Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael C Weisgerber
- Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin
- Departments of Pediatrics
| | - Rena Kasick
- Division of Hospital Medicine, Department of Pediatrics
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Shahzad S, Wajid G. How different is the Learning Environment of Public and Private Sector Medical Colleges in Lahore, Pakistan? Pak J Med Sci 2023; 39:757-763. [PMID: 37250554 PMCID: PMC10214775 DOI: 10.12669/pjms.39.3.6202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/22/2022] [Accepted: 02/26/2023] [Indexed: 11/02/2023] Open
Abstract
Background &Objective Regular assessment of the Learning Environment (LE) of health professions education institutions is important for their continuous improvement and to keep the students motivated. Pakistan Medical & Dental Council (PM&DC) applies uniform standards of quality in all public and private sector medical colleges of the country. However, the learning environment of these colleges might be different due to differences in their geographic location, structure, utilization of resources, and modus operandi. This study was conducted to measure the learning environment in selected public and private sector medical colleges in the city of Lahore, Pakistan, using a pre validated instrument (Jhon Hopkins Learning Environment Scale). Methods This cross-sectional descriptive study was conducted on 3,400 medical students from six public and private sector medical colleges of Lahore, during November and December 2020. Data was collected through Google forms. Two stage cluster random sampling technique was used to draw the study sample. John Hopkins Learning Environment Scale (JHLES) was used for data collection. Results Overall JHLES mean score was 81.75 ±13.5. Public sector colleges had a significantly higher mean JHLES score (82.1) than private-sector colleges (81.1), with small effect size (0.083). Male students rated LE slightly higher than females (82.0 and 81.6 respectively). Conclusion JHLES a relatively simpler tool (28 items) than DREEM, can be used effectively in the context of Pakistani environment to measure the LE in medical colleges. Both, public and private sector colleges had high overall JHLES mean scores, with public sector colleges having a significantly higher score than private-sector colleges.
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Affiliation(s)
- Saadia Shahzad
- Saadia Shahzad, M. Phil (Community Medicine) Associate Professor, Dept. of Community Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Gohar Wajid
- Gohar Wajid, PhD (Medical Education), Health Professions Education Consultant, Pakistan
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Leep Hunderfund AN, West CP, Rackley SJ, Dozois EJ, Moeschler SM, Vaa Stelling BE, Winters RC, Satele DV, Dyrbye LN. Social Support, Social Isolation, and Burnout: Cross-Sectional Study of U.S. Residents Exploring Associations With Individual, Interpersonal, Program, and Work-Related Factors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1184-1194. [PMID: 35442910 DOI: 10.1097/acm.0000000000004709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE To examine associations of social support and social isolation with burnout, program satisfaction, and organization satisfaction among a large population of U.S. residents and fellows and to identify correlates of social support and social isolation. METHOD All residents and fellows enrolled in graduate medical education programs at Mayo Clinic sites were surveyed in February 2019. Survey items measured social support (emotional and tangible), social isolation, burnout, program satisfaction, and organization satisfaction. Factors of potential relevance to social support were collected (via the survey, institutional administrative records, and interviews with program coordinators and/or program directors) and categorized as individual, interpersonal, program, or work-related factors (duty hours, call burden, elective time, vacation days used before survey administration, required away rotations, etc.). Multivariable regression analyses were conducted to examine relationships between variables. RESULTS Of 1,146 residents surveyed, 762 (66%) from 58 programs responded. In adjusted models, higher emotional and tangible support were associated with lower odds of burnout and higher odds of program and organization satisfaction, while higher social isolation scores were associated with higher odds of burnout and lower odds of program satisfaction and organization satisfaction. Independent predictors of social support and/or social isolation included age, gender, relationship status, parental status, postgraduate year, site, ratings of the program leadership team, ratings of faculty relationships and faculty professional behaviors, satisfaction with autonomy, and vacation days used before survey administration. CONCLUSIONS This study demonstrates that social support and social isolation are strongly related to burnout and satisfaction among residents and fellows. Personal and professional relationships, satisfaction with autonomy, and vacation days are independently associated with social support and/or social isolation, whereas most program and work-related factors are not. Additional studies are needed to determine if social support interventions targeting these factors can improve well-being and enhance satisfaction with training.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology, Mayo Clinic, and associate director of clinical learning environment optimization, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Colin P West
- C.P. West is professor of medicine, medical education, and biostatistics, Divisions of General Internal Medicine and Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
| | - Sandra J Rackley
- S.J. Rackley is assistant professor of psychiatry, Mayo Clinic, and assistant dean for trainee well-being, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Eric J Dozois
- E.J. Dozois is professor of surgery, Mayo Clinic, Rochester, Minnesota
| | - Susan M Moeschler
- S.M. Moeschler is associate professor of anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Richard C Winters
- R.C. Winters is assistant professor of emergency medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel V Satele
- D.V. Satele is statistician, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education and co-director of the physician well-being program, Mayo Clinic, Rochester, Minnesota
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The Role of Burnout in the Association between Work-Related Factors and Perceived Errors in Clinical Practice among Spanish Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094931. [PMID: 34066327 PMCID: PMC8124853 DOI: 10.3390/ijerph18094931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate the prevalence of burnout syndrome in a sample of residents from different specialties, to determine the influence of work-related factors on the development of burnout, and to examine the mediating role of burnout in the relation between such work factors and perceived errors in clinical practice. A total of 237 Spanish residents participated (Mage = 28.87, SD = 3.84; 73.8% females). The Maslach Burnout Inventory and an ad hoc questionnaire were administered to assess burnout and work-related factors. Comparison analyses and mediational models were conducted. Half of the residents reported high levels of burnout (48.9%). Burnout was significantly associated with perceived errors in clinical practice. Significant differences were found between residents with lower and higher burnout levels, showing that those with higher burnout were less satisfied with the working conditions. Burnout mediated the associations between adjustment of responsibility, support among residents, satisfaction with teaching and rotations, general satisfaction, and perceived errors in the clinical practice. Adjusted levels of responsibility and workload, enhanced supervision, and more social support from colleagues predict lower levels of burnout, which may result in fewer errors in clinical practice. Consequently, such work-related factors should be taken into account as a preventive strategy for burnout and errors in the clinical practice so adequate patient care, good mental health of future specialists, and, therefore, higher quality of public health care can be ensured.
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