Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs

Abstract

BackgroundThe development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States.MethodsA link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored.ResultsThe response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated.ConclusionsThe majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0941-0) contains supplementary material, which is available to authorized users.

Resident Autonomy

“…With the increasing expectations for resident supervision and the decrease in resident work hours, over the last 15 years, the implementation of 24-hour coverage by hospitalists has become more common, resulting in a decrease in resident experience managing patients without direct supervision immediately available; however, this is not uniformly rated by residents as being detrimental to their education [35,36]. Another time-honored practice for promoting resident autonomy is the continuity clinic, which has been (and in many cases continues to be) a common part of training for pediatric [37], internal medicine [38], neurology [39], obstetrics and gynecology [40], and even ophthalmology [41] residencies. Although the level of supervision in continuity clinics varies by institution [41], continuity clinics provide the opportunity for residents to be involved in longitudinal care, develop a strong sense of ownership for their patients, and practice some degree of independent decision making.…”

“…Another time-honored practice for promoting resident autonomy is the continuity clinic, which has been (and in many cases continues to be) a common part of training for pediatric [37], internal medicine [38], neurology [39], obstetrics and gynecology [40], and even ophthalmology [41] residencies. Although the level of supervision in continuity clinics varies by institution [41], continuity clinics provide the opportunity for residents to be involved in longitudinal care, develop a strong sense of ownership for their patients, and practice some degree of independent decision making.…”

Impact of resident autonomy clinics in a dermatology residency: improving residents’ perception of autonomy

“…Literature from both surgical and medical specialties suggests a gradual decline in resident autonomy over time with ramifications on resident satisfaction and preparedness for future practice. [1][2][3][4][5] Here, we describe the actualization of resident-run autonomy clinics within our programme and compare 2 years of survey data to assess resident perception of autonomy before and after implementation.…”

Supervision and autonomy of ophthalmology residents in the outpatient clinic in the United States II: a survey of senior residents

“…Balancing autonomy and supervision is both a goal and challenge of graduate medical education [1–8]. In a previous report, we presented the landscape of supervision styles for ophthalmology trainees in the outpatient clinic setting [2]. That study, based upon a survey of program directors, suggested that there was no substantial correlation between the level of supervision in the outpatient setting and metrics such as the number of residents in the program, demographic sites of the clinics, number of faculty or contributions of resident-hosted clinics to overall resident surgery volumes.…”