The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy.

Autor:	Allen K; Division of Hospital Medicine, Department of Pediatrics., Najjar M; Division of Hospital Medicine, Department of Pediatrics., Ostermeier A; Division of Hospital Medicine, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri., Washington N; 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., Genies MC; Division of Hospital Medicine, Department of Pediatrics, John Hopkins University School of Medicine, Baltimore, Maryland., Hazle M; Division of Hospital Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan., Hardy C; Center for Clinical Excellence., Lewis K; Division of Hospital Medicine, Department of Pediatrics.; Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio., McDaniel L; Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington., McFarlane DJ; Division of Hospital Medicine, Department of Pediatrics.; Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio., Macias C; Planning and Business Development, Nationwide Children's Hospital, Columbus, Ohio., Molloy MJ; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio., Perry MF; Division of Hospital Medicine, Department of Pediatrics., Piper L; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio., Sevov C; Division of Hospital Medicine, Department of Pediatrics.; Division of Hospital Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio., Titus L; Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin.; Departments of Pediatrics., Toth H; Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin.; Departments of Pediatrics.; Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin., Unaka NI; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio., Weisgerber MC; Division of Hospital Medicine, Children's Wisconsin, Milwaukee, Wisconsin.; Departments of Pediatrics., Kasick R; Division of Hospital Medicine, Department of Pediatrics.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2023 Jun 01; Vol. 13 (6), pp. 490-503.
DOI:	10.1542/hpeds.2022-006827
Abstrakt:	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. (Copyright © 2023 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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