While graduated supervision is necessary for residents to progress to independence, it is currently unclear what factors influence housestaff autonomy. This study examined if attending factors and secular trends predicted faculty perceptions of housestaff autonomy.
General medicine teaching attendings from 2001 to 2008 were administered endofmonth surveys which provided professional demographic data and included items on housestaff autonomy. Due to skewed responses, supporting or providing housestaff autonomy was defined as a response of “Strongly Agree” to the statements: “My resident felt that s/he had sufficient autonomy this month” and “The interns were truly involved in decisionmaking about their patients.” Multivariate logistic regression was done to assess if attending years of practice, hospitalist specialty, and secular trends (i.e., duty hours, season) predicted perceived housestaff autonomy.
Response rate was 71% (514/719). Half of attendings felt residents had sufficient autonomy; 44% felt interns were involved in decisionmaking. In unadjusted analysis, Spring season (i.e., AprilJune) was associated with more intern decisionmaking (54% Spring vs 42% others, P = 0.02). Duty hour limits were associated with less intern decisionmaking (41% vs 57%, P = 0.004) and resident autonomy (46% vs 65%, P = 0.001). Early career attendings (03 years) reported less intern decisionmaking (22% vs 52%, P < 0.001) and resident autonomy (29% vs 59%, P < 0.001). Hospitalists also reported less intern decisionmaking (33% vs 48%, P = 0.01) and resident autonomy (42% vs 54%, P = 0.048). In multivariate analysis, Spring season (OR = 1.88, 95% CI [1.15, 3.09], P = 0.01), duty hours (OR = 0.42, 95%CI [0.24, 0.73], P = 0.002), and early career attendings (OR = 0.32, 95%CI [0.16, 0.61]), P = 0.001) remained significant predictors of intern decisionmaking. Interestingly, the hospitalist main effect was associated with more intern decisionmaking (OR = 3.26, 95%CI [1.13, 9.42], P = 0.03) after adjusting for a significant interaction term representing early career hospitalists, which was associated with less intern decisionmaking (03 years, OR = 0.08, 95%CI [0.015, 0.44] P = 0.004). For resident autonomy, similar effects were seen for duty hours (OR = 0.40, 95%CI [0.22, 0.70], P = 0.002) and early career attendings (OR = 0.36, 95%CI [0.19, 0.68], P = 0.002), with a trend toward significance for Spring season (OR = 1.54, 95%CI [0.94, 2.53], P = 0.089). Hospitalists were also associated with more resident autonomy (OR = 5.27, 95%CI [1.49, 18.7], P = 0.01) after adjusting for a significant early career hospitalist interaction, which was associated with less resident autonomy (03 years, OR = 0.08, 95%CI [0.016, 0.43], P = 0.003).
Attending factors, including hospitalist specialty and experience, as well as secular trends, are important predictors of housestaff autonomy. Understanding these results is especially important for early career hospitalists who are new in their role and may benefit from faculty development.
To cite this abstract:Mayo A, Vekhter B, Meltzer D, Farnan J, Roshetsky L, Martin S, Arora V. Attending Perceptions of Housestaff Autonomy: Time to Teach New Hospitalists Old Tricks?. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97603. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/attending-perceptions-of-housestaff-autonomy-time-to-teach-new-hospitalists-old-tricks/. Accessed September 18, 2019.