Evaluating Medical Decision-Making: Using the EHR to Assess and Structure Resident Autonomy

Resident autonomy has long been a topic of discussion, especially as it relates to clinical decision-making on nights when in-person faculty supervision is less common. In response to changes in the Accreditation Council for Graduate Medical Education requirements, there has been an increase in the presence of attending oversight.^1,2  On one hand, researchers have suggested that having an attending overnight has led to an increase in the education provided for residents during those hours. However, other data have revealed that decreasing resident autonomy with an in-house attending may make residents less prepared for independent practice and does not result in significant changes in patient outcomes.^3,4  One way to evaluate resident medical decision-making (MDM) is to evaluate the orders that are being placed, specifically during a period of limited attending oversight. In this issue of Hospital Pediatrics, Freiman et al⁵  share a study...