549 - “There’s a difference in practice when you have to make the decision”: Autonomy in pediatric emergency medicine fellowship

Poster Number: 549
Publication Number: 549.325

Katherine Dunne, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Vivek Dubey, Children’s Mercy Hospital, Kansas City, MO, United States; Serkan Toy, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States; Camryn Martinez, University of Arkansas, United States; Kelsey Gavin, Children's Mercy Hospital, Kansas City, MO. United States; Christopher Kennedy, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: The Accreditation Council for Graduate Medical Education allows individual training programs to define appropriate supervision and autonomy commensurate with the trainees’ knowledge, clinical competence, and patient complexity and acuity. In pediatric emergency medicine (PEM), supervision is not standardized and subject to supervisor discretion, creating variability in trainee autonomy.

Objective: To explore the concept of autonomy from the perspectives of PEM fellows and faculty.

Design/Methods: We conducted a qualitative study consisting of semi-structured interviews of PEM fellows and faculty from a large, single-center pediatric emergency medicine fellowship program.

A trained interviewer conducted the interviews over an electronic interview platform. Audio recordings of the interviews were transcribed by a trained professional. The written transcriptions were analyzed using a hybrid thematic analysis approach
to identify themes.

Results: 16 faculty and 13 fellows completed interviews.

Field notes suggest data saturation was reached after 6 fellow and 8 faculty interviews.

Preliminary analysis shows that PEM faculty and fellows highly value autonomous clinical decision-making. Departmental policy and economic factors influence the nature of supervision for PEM fellows. The level of supervision is stated to depend on attending factors such as personality and practice style. However, trainees desire a more formalized graduated autonomy structure allowing them to acquire competence for independent clinical practice. 

Conclusion(s): Both fellows and faculty acknowledge the importance of autonomy, but differences exist in how each group views supervision as it facilitates training. Opportunities for fellow autonomy that include complete ownership of patients (without direct attending oversight) are perceived as necessary to learn independent decision-making.