Autonomy in Fellowship Training and Its Influence on Self-Reported Self-Efficacy in Pediatric Emergency Medicine

OBJECTIVES: This study examined the relationship between autonomy during pediatric emergency medicine (PEM) fellowship and self-efficacy in 6 Accreditation Council for Graduate Medical Education-defined entrustable professional activities (EPAs). We hypothesized that experiencing greater autonomy during fellowship would correlate with higher self-efficacy among current fellows and recent graduates. METHODS: An anonymous electronic survey was distributed to current (2021-2022) second- and third-year PEM fellows and first- and second-year PEM attendings who graduated in 2020 and 2021. The survey collected demographic data, self-reported levels of autonomy during fellowship, and self-efficacy ratings for each EPA on a 0 to 100 scale, assessed both currently and retrospectively for 1 year prior. Autonomy was defined as ≥33% of clinical time in indirect supervision or independent practice. Statistical analyses included paired t tests, independent t tests, and multivariate analysis of covariance. RESULTS: One hundred twelve current fellows and 86 recent graduates responded (39% response rate). Both cohorts reported significant self-efficacy improvements across all 6 EPAs over the assessed period (P<0.001 for all comparisons). No significant differences in self-efficacy gains were observed between those who reported experiencing autonomy during fellowship and those who did not (P>0.05). In multivariate analysis, prior self-efficacy was the only consistent predictor of current self-efficacy (P<0.0001), explaining 53% to 71% of variance. CONCLUSIONS: This study found no association between self-reported autonomy in PEM fellowship training and self-efficacy in PEM-specific EPAs. Self-efficacy increased over time among all respondents regardless of autonomy experience. These findings suggest that the relationship between autonomy and trainee development may be more complex than previously assumed and warrants further investigation with refined measurement tools.