Having a Voice: Resident Perceptions of Supervision, Decision-Making and Patient Care Ownership

Margaret A Robinson; Judith L Bowen; Megan Aylor; Sandrijn van Schaik

doi:10.1016/j.acap.2023.10.012

Having a Voice: Resident Perceptions of Supervision, Decision-Making and Patient Care Ownership

Acad Pediatr. 2024 Apr;24(3):519-526. doi: 10.1016/j.acap.2023.10.012. Epub 2023 Nov 10.

Authors

Margaret A Robinson¹, Judith L Bowen², Megan Aylor³, Sandrijn van Schaik⁴

Affiliations

¹ Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif. Electronic address: margaret.robinson@ucsf.edu.
² Elson S. Floyd College of Medicine (JL Bowen), Washington State University, Spokane, Wash.
³ Department of Pediatrics (M Aylor), Oregon Health and Science University, Portland, Ore.
⁴ Division of Pediatric Critical Care Medicine (MA Robinson and S van Schaik), Department of Pediatrics, University of California, San Francisco, Calif.

PMID: 37951350
DOI: 10.1016/j.acap.2023.10.012

Abstract

Objective: Heightened resident supervision due to patient safety concerns is increasingly common in pediatrics and may leave residents with fewer opportunities for independent decision-making, a diminished sense of autonomy, and decreased engagement. This may ultimately threaten their development into competent clinicians. Understanding how pediatric residents experience supervision's influence on their involvement in decision-making, engagement in patient care, and learning is crucial to safeguard their transition to independent practice. In relation to supervision, our research investigated: 1) how residents navigated their involvement with clinical decision-making and 2) how opportunities to make clinical decisions influenced their engagement in patient care and learning.

Methods: From 2019-2020, we recruited 38 pediatric residents from three different programs for a qualitative interview-based study. Through a constructivist stance, we explored clinical decision-making experiences and performed thematic analysis using an iterative and inductive process.

Results: We identified three themes: 1) Residents perceived having autonomy when they had space to make independent decisions, regardless of supervisor's presence; 2) Patient care ownership resulted from having a voice in a variety of contributions to patient care; and 3) Supervisors' behaviors modulated patient care ownership and thereby residents' sense of feeling heard, their engagement in patient care, and their learning.

Conclusions: Our results suggest that focusing on patient care ownership may better fit with current learning environments than aiming for independence and autonomy. They provide insight on how, in the pediatric learning climate of enhanced supervision, supervisors can preserve resident engagement in patient care and learning by augmenting patient care ownership and ensuring residents have a voice.

Keywords: autonomy; decision-making; graduate medical education; learning; supervision.

MeSH terms

Child
Clinical Competence
Humans
Internship and Residency*
Learning
Ownership
Patient Care