The Autonomy Toolbox: A Multicenter Collaborative to Promote Resident Autonomy

Karen Allen, Mohammed Najjar, Austen Ostermeier, Nicole Washington, Marquita C. Genies, Matthew Hazle, Charles Hardy, Kristen Lewis, Lauren McDaniel, Daniel J. McFarlane, Charlie Macias, Matthew J. Molloy, Michael F. Perry, Laura Piper, Claire Sevov, Lauren Titus, Heather Toth, Ndidi I. Unaka, Michael C. Weisgerber, Rena Kasick

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


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.

Original languageEnglish
Pages (from-to)490-498
Number of pages9
JournalHospital Pediatrics
Issue number6
StatePublished - 2023


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