Mieczkowski Alexandra E, Rubio Doris, Van Deusen Reed
J Grad Med Educ. 2014 Jun;6(2):330-4. doi: 10.4300/JGME-D-13-00125.1.
The development of autonomy is a key component of residency training. Although studies have examined levels of graduated autonomy within specialties, they have not, to our knowledge, examined how residents' perceptions of autonomy differ among specialties.
We surveyed residents in internal medicine-pediatrics programs to determine their perceptions of the autonomy they experienced when they were serving on internal medicine (IM) and pediatrics inpatient rotations.
In 2012, we administered a 24-item online survey to residents in 36 internal medicine-pediatrics programs.
Of 698 eligible residents, 143 (20.5%) participated. Participants were distributed equally among all 4 postgraduate years and between IM and pediatrics rotations. Participants were more likely to agree they experienced an appropriate level of autonomy when they were on IM rotations than when they were on pediatrics rotations (97.9% versus 34.3%, P < .001), were more likely to report experiencing frustration with too little oversight while on IM rotations (32.9% versus 2.2%, P < .001), and were more likely to report experiencing frustration with too much oversight while on pediatrics rotations (48.2% versus 0.7%, P < .001). Responses to items that described frequently encountered circumstances and hypothetical medical cases indicated participants were more likely to feel anxiety and discomfort with autonomous decision making while on pediatrics rotations.
Residents in internal medicine-pediatrics programs perceive significant differences in the autonomy they experience during IM and pediatrics rotations. This may influence their confidence in medical decision making.
自主性的发展是住院医师培训的关键组成部分。尽管已有研究考察了各专业毕业生的自主水平，但据我们所知，尚未有研究考察住院医师对自主性的认知在不同专业之间有何差异。
我们对内科 - 儿科项目的住院医师进行了调查，以确定他们在参与内科（IM）和儿科住院轮转时对自身所体验到的自主性的认知。
2012年，我们对36个内科 - 儿科项目的住院医师进行了一项包含24个条目的在线调查。
在698名符合条件的住院医师中，143名（20.5%）参与了调查。参与者在所有4个研究生年级以及IM和儿科轮转之间分布均匀。与儿科轮转时相比，参与者在IM轮转时更倾向于认同他们体验到了适当水平的自主性（97.9%对34.3%，P <.001），在IM轮转时更有可能报告因监督过少而感到沮丧（32.9%对2.2%，P <.001），在儿科轮转时更有可能报告因监督过多而感到沮丧（48.2%对0.7%，P <.001）。对描述常见情况和假设医疗案例的条目的回答表明，参与者在儿科轮转时对自主决策更易感到焦虑和不适。
内科 - 儿科项目的住院医师认为他们在IM和儿科轮转期间所体验到的自主性存在显著差异。这可能会影响他们在医疗决策中的信心。
