Journal Club

Fellows journal Club

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.

Name: Alexandra (Alex) Kilinsky, DO; Cohen Children’s Medical Center of Northwell Health
Fellowship accomplishments/current research: During my fellowship, I have also been working towards my Master’s degree in Health Professions Pedagogy and Leadership, which I plan to complete this summer. I have been working on a QI project to improve Senior Resident autonomy on family centered rounds, where we have been able to show a sustained improvement. I have also created a workshop with our Child Psychiatrists teaching the management of behavioral escalation on the inpatient unit which we have trialed on our hospitalist division and our residents. Additionally, I have been working on an institutional clinical guideline on croup and have continued my position on the GME wellness committee.
Goals/Plans for the future: My goals as a future pediatric hospitalist are to continue to practice and teach evidence based medicine and continue to develop further leadership skills within PHM and medical education.
Fun fact about yourself: I can rotate my arm 360 degrees

Previous Articles: