Walking the Tightrope: Balancing Autonomy and Supervision in Resident Inpatient Education

Balancing attending supervision with resident autonomy is intended to ensure patient safety while allowing trainees to gain graduated independence and demonstrate competency upon completion of residency. Factors such as ACGME duty hour restrictions and patient safety initiatives have increased attending supervision, but their effect on resident education and autonomy is unclear. Additionally, the balance of autonomy and supervision - and the factors that contribute to that balance - are complex, nuanced, and poorly understood. It is during inpatient rotations that supervising attendings often navigate the dynamics of autonomy and supervision with residents to achieve these goals.

In this workshop, we explore the perspectives from residents and attendings through surveys and focus groups from our three-site academic center. Our survey demonstrates a tension that attendings experience between the culture they desire to create and the barriers of perceived norms and current culture. Our focus group results expand an understanding of ways that resident and faculty viewpoints on contributors compare and contrast. From these perspectives, we offer insight into ways that attendings may navigate how to adjust their supervision depending on characteristics from patients, residents, and the clinical environment.