SHM Converge Scientific Abstract ePoster Gallery-Comparing Resident and Attending Perspectives Around the Culture of Autonomy and Supervision

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This study surveyed residents in a large internal medicine residency to compare their views on autonomy and supervision with previously collected attending perspectives. The goal was to better understand the clinical learning environment and how residents want supervision to be balanced with independent decision-making.<br /><br />A 19-item survey was sent to residents rotating across three clinical sites, and responses were analyzed using descriptive statistics and content analysis of free-text comments. Resident responses were then compared with attending physician responses from an earlier survey.<br /><br />Overall, both residents and attendings preferred a more autonomous culture than the one they perceived in current practice. However, residents viewed the current environment as more autonomous than attendings did, and residents also wanted even more autonomy in their ideal setting. In cases where resident and attending responses differed, attendings generally favored greater supervision.<br /><br />Across clinical vignettes, both groups showed similar patterns: they supported resident autonomy in routine or stable situations, but preferred increased supervision when patient acuity changed or the clinical situation became unstable. This was especially evident in scenarios involving deterioration, such as sepsis, ICU transfer, or unexpected arrest. <br /><br />The findings suggest that residents and attendings agree in principle on promoting autonomy, but attendings are more cautious, particularly when patient status worsens. The authors conclude that residency programs should recognize both the desire for autonomy and the need for supervision, especially during changes in acuity, to support both patient safety and resident development.

Asset Subtitle

Jessica S. Fuller

Meta Tag

Author List James D. Harrison, Jessica S. Fuller, Nancy Choi, Peter Barish, Sirisha Narayana, Sneha Daya, Stephanie Conner, Stephanie Rennke

Category Research

Concept Resident Autonomy

Concept Clinical Supervision

Concept Resident Physician

Concept Attending Physician

Concept Clinical Decision-Making

Distinguished Non-Finalist

Presenter Organization University of North Carolina - Chapel Hill

Presenting Author Jessica S. Fuller

Track Education

Keywords

resident autonomy

attending supervision

internal medicine residency

clinical learning environment

descriptive statistics

content analysis

patient acuity

clinical vignettes

resident survey

medical education

Resident Autonomy

Clinical Supervision

Resident Physician

Attending Physician

Clinical Decision-Making