Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide?

Eric Biondi, William S. Varade, Lynn C. Garfunkel, Justin F. Lynn, Mark S. Craig, Melissa M. Cellini, Laura P. Shone, J. Peter Harris, Constance D. Baldwin

Research output: Contribution to journalArticle

Abstract

Purpose To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy. Method Parallel questionnaires were sent to pediatric residents and faculty at the University of Rochester Medical Center in 2011. Items addressed self-determination theory (SDT) constructs (autonomy, competence, relatedness) and asked residents and faculty to rate and/or comment on their own and the other group's behaviors. Distributions of responses to 17 parallel Likert scale items were compared by Wilcoxon rank-sum tests. Written comments underwent qualitative content analysis. Results Respondents included 62/78 residents (79%) and 71/100 faculty (71%). The groups differed significantly on 15 of 17 parallel items but agreed that faculty sometimes provided too much direction. Written comments suggested that SDT constructs were closely interrelated in residency training. Residents expressed frustration that their care plans were changed without explanation. Faculty reported reluctance to give "passive" residents autonomy in patient care unless stakes were low. Many reported granting more independence to residents who displayed motivation and competence. Some described working to overcome residents' passivity by clarifying and reinforcing expectations. Conclusions Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of "passive" residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.

Original languageEnglish (US)
Pages (from-to)462-471
Number of pages10
JournalAcademic Medicine
Volume90
Issue number4
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

Fingerprint

Personal Autonomy
self-determination
autonomy
resident
Mental Competency
Nonparametric Statistics
Problem-Based Learning
Frustration
Accreditation
Internship and Residency
Motivation
Patient Care
Pediatrics
Growth

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Discordance between resident and faculty perceptions of resident autonomy : Can self-determination theory help interpret differences and guide strategies for bridging the divide? / Biondi, Eric; Varade, William S.; Garfunkel, Lynn C.; Lynn, Justin F.; Craig, Mark S.; Cellini, Melissa M.; Shone, Laura P.; Harris, J. Peter; Baldwin, Constance D.

In: Academic Medicine, Vol. 90, No. 4, 01.04.2015, p. 462-471.

Research output: Contribution to journalArticle

Biondi, Eric ; Varade, William S. ; Garfunkel, Lynn C. ; Lynn, Justin F. ; Craig, Mark S. ; Cellini, Melissa M. ; Shone, Laura P. ; Harris, J. Peter ; Baldwin, Constance D. / Discordance between resident and faculty perceptions of resident autonomy : Can self-determination theory help interpret differences and guide strategies for bridging the divide?. In: Academic Medicine. 2015 ; Vol. 90, No. 4. pp. 462-471.
@article{3f6f0eb53c7240f5a38c7653875479e8,
title = "Discordance between resident and faculty perceptions of resident autonomy: Can self-determination theory help interpret differences and guide strategies for bridging the divide?",
abstract = "Purpose To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy. Method Parallel questionnaires were sent to pediatric residents and faculty at the University of Rochester Medical Center in 2011. Items addressed self-determination theory (SDT) constructs (autonomy, competence, relatedness) and asked residents and faculty to rate and/or comment on their own and the other group's behaviors. Distributions of responses to 17 parallel Likert scale items were compared by Wilcoxon rank-sum tests. Written comments underwent qualitative content analysis. Results Respondents included 62/78 residents (79{\%}) and 71/100 faculty (71{\%}). The groups differed significantly on 15 of 17 parallel items but agreed that faculty sometimes provided too much direction. Written comments suggested that SDT constructs were closely interrelated in residency training. Residents expressed frustration that their care plans were changed without explanation. Faculty reported reluctance to give {"}passive{"} residents autonomy in patient care unless stakes were low. Many reported granting more independence to residents who displayed motivation and competence. Some described working to overcome residents' passivity by clarifying and reinforcing expectations. Conclusions Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of {"}passive{"} residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.",
author = "Eric Biondi and Varade, {William S.} and Garfunkel, {Lynn C.} and Lynn, {Justin F.} and Craig, {Mark S.} and Cellini, {Melissa M.} and Shone, {Laura P.} and Harris, {J. Peter} and Baldwin, {Constance D.}",
year = "2015",
month = "4",
day = "1",
doi = "10.1097/ACM.0000000000000522",
language = "English (US)",
volume = "90",
pages = "462--471",
journal = "Academic Medicine",
issn = "1040-2446",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Discordance between resident and faculty perceptions of resident autonomy

T2 - Can self-determination theory help interpret differences and guide strategies for bridging the divide?

AU - Biondi, Eric

AU - Varade, William S.

AU - Garfunkel, Lynn C.

AU - Lynn, Justin F.

AU - Craig, Mark S.

AU - Cellini, Melissa M.

AU - Shone, Laura P.

AU - Harris, J. Peter

AU - Baldwin, Constance D.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Purpose To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy. Method Parallel questionnaires were sent to pediatric residents and faculty at the University of Rochester Medical Center in 2011. Items addressed self-determination theory (SDT) constructs (autonomy, competence, relatedness) and asked residents and faculty to rate and/or comment on their own and the other group's behaviors. Distributions of responses to 17 parallel Likert scale items were compared by Wilcoxon rank-sum tests. Written comments underwent qualitative content analysis. Results Respondents included 62/78 residents (79%) and 71/100 faculty (71%). The groups differed significantly on 15 of 17 parallel items but agreed that faculty sometimes provided too much direction. Written comments suggested that SDT constructs were closely interrelated in residency training. Residents expressed frustration that their care plans were changed without explanation. Faculty reported reluctance to give "passive" residents autonomy in patient care unless stakes were low. Many reported granting more independence to residents who displayed motivation and competence. Some described working to overcome residents' passivity by clarifying and reinforcing expectations. Conclusions Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of "passive" residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.

AB - Purpose To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy. Method Parallel questionnaires were sent to pediatric residents and faculty at the University of Rochester Medical Center in 2011. Items addressed self-determination theory (SDT) constructs (autonomy, competence, relatedness) and asked residents and faculty to rate and/or comment on their own and the other group's behaviors. Distributions of responses to 17 parallel Likert scale items were compared by Wilcoxon rank-sum tests. Written comments underwent qualitative content analysis. Results Respondents included 62/78 residents (79%) and 71/100 faculty (71%). The groups differed significantly on 15 of 17 parallel items but agreed that faculty sometimes provided too much direction. Written comments suggested that SDT constructs were closely interrelated in residency training. Residents expressed frustration that their care plans were changed without explanation. Faculty reported reluctance to give "passive" residents autonomy in patient care unless stakes were low. Many reported granting more independence to residents who displayed motivation and competence. Some described working to overcome residents' passivity by clarifying and reinforcing expectations. Conclusions Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of "passive" residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.

UR - http://www.scopus.com/inward/record.url?scp=84930340452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930340452&partnerID=8YFLogxK

U2 - 10.1097/ACM.0000000000000522

DO - 10.1097/ACM.0000000000000522

M3 - Article

C2 - 25340363

AN - SCOPUS:84930340452

VL - 90

SP - 462

EP - 471

JO - Academic Medicine

JF - Academic Medicine

SN - 1040-2446

IS - 4

ER -