Center for FAME

Title / Moving Your Learner from Supervision to Autonomy: Achieving the Right Balance
Date / Nov 4, 2016 / Time / 12:00-1:00 PM
Place / OSUMC / Room / James B050
Description / Clinical supervision, is essential to health professions education. Supervision involves tailoring the degree of oversight to the level of expertise of the learner to promote learner development while ensuring best patient outcomes: more junior learners need closer supervision, and more senior learners need more autonomy. After a brief review of the latest thinking about balancing supervision and autonomy the presenters will discuss strategies they have used to help learners progress from supervision to autonomy.
Instructors / Jennifer McCallister MD; John D Mahan MD
Learners /
  • Participants: faculty and trainees in the OSU COM

Learning Goals /
  • Define the concepts of autonomy and supervisionin medical education.
  • Describe the impact of graded and progressive responsibility on the attainment of competence in medical professionals.
  • Describe the ‘weird educational science’ constructs (Milestones, EPAs, Trustworthiness, Zone of Proximal Development) that increasingly define how students and trainees are developed.
  • Describe techniques used by our faculty to accord the appropriate levels of supervision and autonomy to students and trainees.

Assessment /
  • Questions posed; engagement
  • FAME Commitment to Action
  • FAME Follow-up Surveys: evaluation & Success in Commitment to Action Plan

Teaching /
  • Case scenarios, didactics, discussion

Encouraging Ongoing Application /
  • Hauer KE, Oza SK, Kogan JR, Stankiewicz CA, Stenfors-Hayes T, Cate OT, Batt J, O’Sullivan PS. How clinical supervisors develop trust in their trainees: a qualitative study. Medical Education. 2015;49:783-95.
  • Kennedy TJT. Progressive Independence in Clinical Training. Acad Med. 2005;80:S106-111.
  • Kennedy TJ. Dimensions of Trustworthiness. Acad Med 2008.
  • Sheu L et al. How Residents Develop Trust in Interns. Acad Med. 2016;91:1406-1415.

Key Points
1. Responsibility: the state or fact of being answerable or accountable
2. Autonomy: independence or freedom, as of the will or one's actions
3. Autonomy: independence or freedom, as of the will or one's actions
4. 4 Levels of Supervision
Direct Supervision: the supervising physician is physically present withthe resident and patient.
Indirect Supervision/With direct supervision immediately available: the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision.
Indirect Supervision/With direct supervision available: the supervising physician is not physically present within the hospital or other site of patient care, but is immediately available by means of telephonic and/or electronic modalities, and is available to provide Direct Supervision.
Oversight: the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
5. Dimensions of Trustworthiness
Knowledge and skill: Relevant to the clinical activity
Discernment: Awareness of limitations
Conscientiousness: Thoroughness, dependability
Truthfulness: Absence of deception
Kennedy TJ. Dimensions of Trustworthiness. Acad Med 2008
6.

7. Autonomy & Supervision: Methods/Tools
SUPERB/SAFETY Models (Farnan)
SUPERB/SAFETY model. Effectivestrategies for attending physician provision of supervision:
SUPERB: Set expectations for when to benotified, Uncertainty is a time to contact, Plannedcommunication, Easily available, Reassure fears, andBalance supervision and autonomy.
Domains thatdescribed times for residents to solicit faculty supervision:
SAFETY: Seek attending physician input early,Active clinical decisions, Feeling uncertain about clinical
decisions, End-of-life care or family/legal issues,Transitions of care, and You need help with the system/hierarchy. [IM]
Resident Supervision Index (Byrne)
Resident Supervision Index (RSI): measures supervision in terms of 1) attending physician time spent in engagement, 2) resident’s’ case understanding,and 3) items involved in interaction [IM, Surg, Psych)
Resident Autonomy Experience (Hinchey)
IM residents - 4 qualities defined effective experience as manager: ownershipof patients, accountability to others,competence in patient managementskills, and personal satisfaction [IM]