The Educational Role of Autonomy in Medical Training: A Scoping Review

Abstract

Background: Recent limits imposed on autonomy have raised concern regarding the quality of medical training. The impact of autonomy on medical education has not been comprehensively reviewed. A scoping review was performed to understand the significance of autonomous practice in medical training.

Methods: The MEDLINE and Embase databases were searched for all studies on the role of autonomy in medical training. Articles were included that referenced the medical profession or trainees, and "autonomy," "independence," or "supervision". Data were qualitatively synthesized and analyzed.

Results: The search yielded 3649 articles of which 189 were included. Fourteen studies specifically investigated the role of autonomy: 10 surveys on resident perception, and four studies comparing the effect of supervision on learning outcomes. The remaining 175 publications described participant (88) or author (87) opinions regarding the benefits of autonomy as an educational strategy. One quarter (48) of the publications specifically pertained to surgical disciplines, of which one specifically investigated the role of autonomy. Common themes associated autonomy with increased confidence, readiness for independent practice, the development of clinical decision-making skills, and professional identity.

Conclusions: The current literature primarily represents the opinions of medical educators and trainees. A better understanding of the role of autonomy could inform the development of strategies to compensate for the gap left by the current context of decreased autonomy in medical training.

Keywords: Autonomy; Independence; Medical education; Medical training; Residency training; Supervision.