Autonomy and developing physicians: Reimagining supervision using self‐determination theory

Abstract

In this article, we address the question, 'What is the role of autonomy in physician development?' by exploring the relationship between supervision and autonomy in the clinical learning environment. We propose a reconceptualisation of this relationship that moves away from autonomy as independence from supervision and towards a concept of supervision grounded in autonomy support

Beyond competence: Towards a more holistic perspective in medical education

“…In another conceptual paper, 5 Sawatsky and colleagues argue that supervisors should gradually provide autonomy in clinical decision making to facilitate the development of (well‐calibrated) confidence in their trainees. The authors conceptualise autonomy not as ‘independence from supervision’ but as a source of motivation that drives learning.…”

Nurturing the “self” in health professions education

“…In particular, Bransen et al 1 challenge the naïve and traditional conception of self‐direction as the optimal means of regulating learning, prioritising instead a socially shared regulation that captures the social embeddedness of the self. Gottlieb et al 2 underscore the need to align confidence and competence to ensure patient safety in professional practice in a manner that requires considering the particulars of context; Mendelsohn D 4 highlight the vulnerability of health care professionals and students and emphasise the importance of our environment in enabling psychological wellness, and finally, Sawatsky et al, 5 aim to reconceptualise autonomy in the context of clinical supervision.…”

“…First , these articles elucidate the malleable nature of the self and suggest, therefore, that its development should not be taken as outright or even stable; rather, the self should be construed as responsive to the stimulation of external agencies, with identity and self‐perception swaying as a result of various social and situational factors. For example, Sawatsky et al 5 suggest an important role of clinical supervisors to be facilitating conditions that support learner autonomy and physician development by enabling students' ability to enact choices that are in line with their values and interests and, thereby, are likely to be linked with adaptive outcomes. Gottlieb et al 2 similarly speak to the critical role of teachers in enabling students to calibrate their confidence relative to competence.…”

“…Third , one need not lose sight of the “self” to accept the value of and influence of external supports. This contention was prominent in Sawatsky et al's 5 argument that autonomy can be enabled in the context of clinical supervision by providing choice of opportunities for trainees. “From sage on the stage” to “guide on the side” characterises how the teacher's role might need to change to take advantage of the benefits that come from students feeling in control of their learning.…”

“…That is because within most competency frameworks autonomy is operationalised as independence and viewed as the end goal of training. Sawatsky et al 5 offer an alternative model, drawing upon motivation science to suggest that synergy is possible if we reconceptualize autonomy in the context of supervision in medical education through the lens of self‐determination theory 6 …”