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Trainee Autonomy Is Associated With Wellbeing
Christina L. Cui
1, Margaret A. Reilly, MD
2, Eric B. Pillado, MD, MBA, MS
2, Ruojia D. Li, MD
3, Joshua S. Eng, PhD
4, Leanne E. Grafmuller, MD
5, Kathryn L. DiLosa, MD, MPH
6, Allan M. Conway, MD
7, Guillermo A. Escobar, MD
8, Palma M. Shaw, MD, MBA
9, Yue-yung Hu, MD, MPH
2, Karl Y. Bilimoria, MD, MS
4, Malachi G. Sheahan, III, MD
10, Dawn M. Coleman, MD
1.
1Duke University, Durham, NC, USA,
2Northwestern University, Chicago, IL, USA,
3Loyola University, Chicago, IL, USA,
4Indiana University, Indianapolis, IN, USA,
5University of Rochester, Rochester, NY, USA,
6University of California, Davis, Sacramento, CA, USA,
7University of California, San Francisco, San Francisco, CA, USA,
8Emory University, Atlanta, GA, USA,
9Upstate Medical University, Syracuse, NY, USA,
10Louisiana State University, New Orleans, LA, USA.
OBJECTIVES: Concerns around progressive entrustment have grown in the past decade, especially with changes in the vascular surgery training paradigm. The purpose of this study is to evaluate vascular surgery trainee perceptions of autonomy and its associations with their learning environment.
METHODS: Data was collected from a confidential, voluntary survey administered after the 2020-2024 VSITE as part of the SECOND trial. Autonomy was defined by operative autonomy, clinical autonomy, and operative time. Trainees ranked their degree of satisfaction with each component on a Likert scale, which was subsequently dichotomized. Univariable logistic and multivariable logistic regression were used.
RESULTS: A total of 3,272 survey results were collected from 2020-2024. Approximately 3.9% (n=117) of survey responses reported dissatisfaction with their operative autonomy, 2.0% (n=52) responses reported dissatisfaction with their clinical autonomy, and 4.2% (n=93) responses reported dissatisfaction with the amount of time they spend in the operating room. These rates did not change over time (p>0.05). Within responses from 2024, the only demographic variable significantly different between the group of trainees who were dissatisfied and the group of trainees who were satisfied with their autonomy was gender (dissatisfaction: 12% females versus 5% males, p=0.016). In comparison, all learning environment factors were significantly different between groups (p<0.001). On adjusted analysis, dissatisfaction with autonomy was driven by trainee perceptions of faculty engagement (odds ratio (OR) 4.8, 95% confidence interval (CI) 1.9-12, p<0.001) and efficiency and program resources (OR 10.9, 95%CI 4.4-26.8, p<0.001). Perceptions of autonomy also had significant associations with wellbeing metrics. Trainees who reported dissatisfaction with their autonomy were at increased odds of professional dissatisfaction (OR 11.6, 95%CI: 4.7-28.6, p<0.001), personal dissatisfaction (OR 4.4, 95%CI: 2.1-9.2, p<0.001), weekly symptoms of burnout (OR 10.9, 95%CI: 4.2-28.2, p<0.001), thoughts of attrition (OR 10.7, 95%CI: 5.1-22.4, p<0.001) and suicidal ideation (OR 6.1, 95%CI: 1.7-22.4, p=0.006). (
Table 1)
CONCLUSIONS: A minority of vascular trainees express dissatisfaction with their autonomy. Those who do also have higher odds of adverse training experiences, including burnout, work life conflict, thoughts of attrition, and suicidal ideation. Program monitoring of trainee autonomy and operative time may mitigate this risk.
Table 1: Odds ratio of autonomy perception on wellness metrics, unadjusted| Outcome | Odds Ratio | Lower 95% Confidence Interval | Upper 95% Confidence Interval | P-value |
| Professional Satisfaction | 11.6 | 4.7 | 28.6 | <0.001 |
| Personal Satisfaction | 4.4 | 2.1 | 9.2 | <0.001 |
| Burnout | 10.9 | 4.2 | 28.2 | <0.001 |
| Thoughts of Attrition | 10.7 | 5.1 | 22.4 | <0.001 |
| Suicidal Ideation | 6.1 | 1.7 | 22.4 | 0.0006 |
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