The long game: Evolution of clinical decision making throughout residency and fellowship.

Structured Abstract Background The purpose of this study was to explore the trajectory of autonomy in clinical decision making. Methods We conducted a qualitative secondary analysis of interviews with 45 residents and fellows from the General Surgery and Obstetrics & Gynecology departments across all clinical postgraduate years (PGY) using convenience sampling. Each interview was recorded, transcribed and iteratively analyzed using a framework method. Results A total of 16 junior residents, 22 senior residents and 7 fellows participated in 12 original interviews. Early in training residents take their abstract ideas about disease processes and make them concrete in their applications to patient care. A transitional stage follows in which residents apply concepts to concrete patient care. Chief residents re-abstract their concrete technical and clinical knowledge to prepare for future surgical practice. Conclusions Understanding where each learner is on this pathway will assist development of curriculum that fosters resident readiness for practice at each PGY level.