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December 25, 2013

The Quest Toward Unsupervised Practice: Promoting Autonomy, Not Independence

Author Affiliations
  • 1Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts
  • 2Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 3Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison
JAMA. 2013;310(24):2613-2614. doi:10.1001/jama.2013.282324

The ultimate goal of graduate medical education has often been described as supporting learners in the pursuit of independent practice. To achieve this goal, learners and supervisors attempt to balance autonomy vs supervision, defining autonomy as allowing a learner to make decisions in the absence of a supervisor, and supervision as ensuring that ultimate care decisions are in the control of a more experienced physician. These definitions are not only outmoded but perhaps were never correct. Instead, training must prepare learners for unsupervised practice, in which they interact with others (not act independently) and are afforded appropriate autonomy and levels of supervision during training.

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