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- W2214249082 abstract "Autonomy and escalation are words that are addressed in the May issue of Annals of Surgery. As we approach a new year of training for surgical residents, the expectations for autonomy and escalation weigh heavily on trainees and faculty members. Autonomy is expected by the trainees whereas faculty members are constantly trying to provide it. Autonomy is described and perceived in many different ways, but our training programs embrace it as opportunities for progressive graduated responsibilities. Our current training model is often considered deficit in allowing this to happen. The reasons given are many and adequately listed by Sandhu et al. I acknowledge that satisfying trainee and faculty perception of autonomy is difficult. Although external forces are a concern, we must develop a training paradigm that honestly addresses autonomy and helps resident and faculty members navigate the treacherous waters. The degree of autonomy is a common discussion especially among our chief residents. How much is expected? How much is given? How much is deserved? It is just as common a discussion among junior residents, although the urgency maybe less. The answers for all trainees are not obvious, especially as the health care landscape continues to change. Autonomy is really about the length of rope that a given resident is allowed by a given teacher before they are expected to ask for assistance. All faculty members have ropes. None are exactly the same length, and many teachers have different lengths for different levels of residents or even just different residents. Our goal as teachers must be to use appropriate rope lengths that support a degree of autonomy without stifling its development. At the same time, we must continue to function as a patient advocate ensuring safe and effective care. Safe and effective care while allowing autonomous activity of our trainees is a delicate balance. Part of the balance is establishing expectations for our residents about when they need to escalate a problem to a higher level of knowledge or experience. Explicit expectations and escalation can help develop autonomy. Setting the expectations is the act of giving instructions to our trainees. These are no more than guidelines for their behavior on the rotation. It is doubtful that every small detail of any rotation can be covered, but it is probable that the classic 80/20 rule exists: expectations can cover at least" @default.
- W2214249082 created "2016-06-24" @default.
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- W2214249082 date "2015-07-01" @default.
- W2214249082 modified "2023-09-23" @default.
- W2214249082 title "Expectations and Escalation" @default.
- W2214249082 cites W1985058508 @default.
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- W2214249082 doi "https://doi.org/10.1016/j.jsurg.2015.04.006" @default.
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