Fellow: Alexandra Kilinsky, Cohen Children’s Medical Center of Zucker School of Medicine at Hofstra/Northwell
Article: Maniscalco J, Davis E, Gay AC et al. Factors and Behaviors Related to the Promotion of Pediatric Hospital Medicine Fellow Autonomy: A qualitative study of faculty. Academic Pediatrics. 2019; 19(6):703-711
Summary: This was a multicenter, qualitative research study looking to identify factors that faculty members associate with the promotion, or lack thereof, of autonomy of PHM fellows, and to describe strategies to promote autonomy in clinical settings. The study found that the factors that are associated with the promotion of autonomy are:
a. Faculty factors:
-Experience and style. There was a positive correlation between years in practice and comfort
in promoting fellow autonomy
-Their personal understanding of the role of autonomy in medical education
-Their investment in their role as educators
b. Fellow factors:
-Fund of knowledge, skills as an educator
-Leadership, communication and interpersonal skills specifically self-awareness and proactivity
c. Case factors:
-Faculty described low-stakes consequences such as “undue expense” and high-stakes
consequences such as “patient harm” that would influence them to promote autonomy
-These low and high-stake situations were described both in clinical scenarios and in
the management of patient/family satisfaction
Faculty described strategies to promote PHM fellow autonomy including: using various levels of supervision (such as direct and indirect supervision), scaffolding, defining roles and responsibilities and using direct observation with feedback.
Key Strengths: This topic is relevant and timely for PHM as a field. The specificity of factors described adds to the existing literature on the topic of graduated autonomy in medical education and gives programs detailed ideas for implementing initiatives within their programs/divisions to drive change.
Limitations: Data on whether or not the faculty themselves were fellowship trained was not captured. Completion of a fellowship would likely alter their perceptions of autonomy. Additionally, the perceptions of PHM fellows as it pertains to their own autonomy was not explored.
Major Takeaway/Impact on Practice: For the faculty, the importance of defining roles and expectations is highlighted here as well as the potential for faculty development initiatives including: what is autonomy and why is it important, the creation of goals of PHM fellowship and practical strategies to promote autonomy in their practice. For current/future PHM fellows, this article gives us tangible areas to work on to achieve graduated autonomy with mentorship from our institution/PHM community at large.
Article: Maniscalco J, Davis E, Gay AC et al. Factors and Behaviors Related to the Promotion of Pediatric Hospital Medicine Fellow Autonomy: A qualitative study of faculty. Academic Pediatrics. 2019; 19(6):703-711
Summary: This was a multicenter, qualitative research study looking to identify factors that faculty members associate with the promotion, or lack thereof, of autonomy of PHM fellows, and to describe strategies to promote autonomy in clinical settings. The study found that the factors that are associated with the promotion of autonomy are:
a. Faculty factors:
-Experience and style. There was a positive correlation between years in practice and comfort
in promoting fellow autonomy
-Their personal understanding of the role of autonomy in medical education
-Their investment in their role as educators
b. Fellow factors:
-Fund of knowledge, skills as an educator
-Leadership, communication and interpersonal skills specifically self-awareness and proactivity
c. Case factors:
-Faculty described low-stakes consequences such as “undue expense” and high-stakes
consequences such as “patient harm” that would influence them to promote autonomy
-These low and high-stake situations were described both in clinical scenarios and in
the management of patient/family satisfaction
Faculty described strategies to promote PHM fellow autonomy including: using various levels of supervision (such as direct and indirect supervision), scaffolding, defining roles and responsibilities and using direct observation with feedback.
Key Strengths: This topic is relevant and timely for PHM as a field. The specificity of factors described adds to the existing literature on the topic of graduated autonomy in medical education and gives programs detailed ideas for implementing initiatives within their programs/divisions to drive change.
Limitations: Data on whether or not the faculty themselves were fellowship trained was not captured. Completion of a fellowship would likely alter their perceptions of autonomy. Additionally, the perceptions of PHM fellows as it pertains to their own autonomy was not explored.
Major Takeaway/Impact on Practice: For the faculty, the importance of defining roles and expectations is highlighted here as well as the potential for faculty development initiatives including: what is autonomy and why is it important, the creation of goals of PHM fellowship and practical strategies to promote autonomy in their practice. For current/future PHM fellows, this article gives us tangible areas to work on to achieve graduated autonomy with mentorship from our institution/PHM community at large.