{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:31:52Z","timestamp":1793327512094,"version":"4.5.0"},"reference-count":35,"publisher":"Elsevier BV","issue":"8","license":[{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:00:00Z","timestamp":1793491200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100019659","name":"The George Washington University School of Medicine and Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100024057","name":"School of Medicine and Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100024057","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["academicpedsjnl.net","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Academic Pediatrics"],"published-print":{"date-parts":[[2026,11]]},"DOI":"10.1016\/j.acap.2026.103457","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:31:31Z","timestamp":1790098291000},"page":"103457","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolving Conceptualizations of Autonomy: A Longitudinal Study of Pediatric Hospital Medicine Fellows into Attending Practice"],"prefix":"10.1016","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7307-6289","authenticated-orcid":false,"given":"Valerie","family":"Jurgens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Librizzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0348-7443","authenticated-orcid":false,"given":"Neha","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7624-7286","authenticated-orcid":false,"given":"Priti","family":"Bhansali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6805-4062","authenticated-orcid":false,"given":"Dorene F.","family":"Balmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jimmy","family":"Beck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.acap.2026.103457_bib1","first-page":"1","article-title":"Integrating fixed norms and relational responsiveness in medical education: redefining autonomy","author":"Haruta","year":"2025","journal-title":"Med Teach"},{"issue":"4","key":"10.1016\/j.acap.2026.103457_bib2","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1097\/ACM.0000000000000522","article-title":"Discordance between resident and faculty perceptions of resident autonomy: can self-determination theory help interpret differences and guide strategies for bridging the divide?","volume":"90","author":"Biondi","year":"2015","journal-title":"Acad Med"},{"issue":"7","key":"10.1016\/j.acap.2026.103457_bib3","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1111\/medu.14073","article-title":"Autonomy and professional identity formation in residency training: a qualitative study","volume":"54","author":"Sawatsky","year":"2020","journal-title":"Med Educ"},{"issue":"3","key":"10.1016\/j.acap.2026.103457_bib4","article-title":"Autonomy versus independence: implications for resident and faculty engagement, performance, and well-being","volume":"5","author":"Neufeld","year":"2024","journal-title":"HCA Healthc J Med"},{"key":"10.1016\/j.acap.2026.103457_bib5","doi-asserted-by":"crossref","unstructured":"Neufeld A. When I say autonomy. Medical Education. doi:https:\/\/doi.org\/10.1111\/medu.70051.","DOI":"10.1111\/medu.70051"},{"issue":"2","key":"10.1016\/j.acap.2026.103457_bib6","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.amjsurg.2021.03.023","article-title":"The long game: evolution of clinical decision making throughout residency and fellowship","volume":"223","author":"Woelfel","year":"2022","journal-title":"Am J Surg"},{"issue":"1","key":"10.1016\/j.acap.2026.103457_bib7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.jamcollsurg.2009.09.043","article-title":"Operating from the other side of the table: control dynamics and the surgeon educator","volume":"210","author":"Moulton","year":"2010","journal-title":"J Am Coll Surg"},{"issue":"5","key":"10.1016\/j.acap.2026.103457_bib8","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1542\/peds.2011-2674","article-title":"The dance between attending physicians and senior residents as teachers and supervisors","volume":"129","author":"Balmer","year":"2012","journal-title":"Pediatrics"},{"issue":"9","key":"10.1016\/j.acap.2026.103457_bib9","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/medu.13655","article-title":"Supervised workplace learning in postgraduate training: a realist synthesis","volume":"52","author":"Wiese","year":"2018","journal-title":"Med Educ"},{"issue":"7","key":"10.1016\/j.acap.2026.103457_bib10","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1365-2923.2009.03382.x","article-title":"It\u2019s a cultural expectation\u2026\u2019 The pressure on medical trainees to work independently in clinical practice","volume":"43","author":"Kennedy","year":"2009","journal-title":"Med Educ"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib11","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/medu.14465","article-title":"An act of performance: exploring residents\u2019 decision-making processes to seek help","volume":"55","author":"Jansen","year":"2021","journal-title":"Med Educ"},{"issue":"1","key":"10.1016\/j.acap.2026.103457_bib12","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.19316","article-title":"Longitudinal assessment of resident performance using entrustable professional activities","volume":"3","author":"Schumacher","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"8","key":"10.1016\/j.acap.2026.103457_bib13","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1111\/medu.14520","article-title":"The wolf you feed: challenging intraprofessional workplace-based education norms","volume":"55","author":"Stalmeijer","year":"2021","journal-title":"Med Educ"},{"issue":"4","key":"10.1016\/j.acap.2026.103457_bib14","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1207\/S15327965PLI1104_01","article-title":"The \u201cWhat\u201d and \u201cWhy\u201d of goal pursuits: human needs and the self-determination of behavior","volume":"11","author":"Deci","year":"2000","journal-title":"Psychol Inq"},{"issue":"1","key":"10.1016\/j.acap.2026.103457_bib15","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/medu.14580","article-title":"Autonomy and developing physicians: Reimagining supervision using self-determination theory","volume":"56","author":"Sawatsky","year":"2022","journal-title":"Med Educ"},{"issue":"8","key":"10.1016\/j.acap.2026.103457_bib16","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1542\/hpeds.2024-007855","article-title":"Pediatric hospital medicine fellows\u2019 perspectives on autonomy through time","volume":"14","author":"Jurgens","year":"2024","journal-title":"Hosp Pediatr"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib17","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1016\/j.jsurg.2020.05.023","article-title":"Mind the gap: the autonomy perception gap in the operating room by surgical residents and faculty","volume":"77","author":"Kim","year":"2020","journal-title":"J Surg Educ"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib18","doi-asserted-by":"crossref","first-page":"e182","DOI":"10.1016\/j.jsurg.2019.06.006","article-title":"Does perceived resident operative autonomy impact patient outcomes?","volume":"76","author":"Fieber","year":"2019","journal-title":"J Surg Educ"},{"issue":"9","key":"10.1016\/j.acap.2026.103457_bib19","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1001\/archpedi.156.9.877","article-title":"Effect of a pediatric hospitalist system on housestaff education and experience","volume":"156","author":"Landrigan","year":"2002","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"7","key":"10.1016\/j.acap.2026.103457_bib20","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1016\/j.acra.2013.10.022","article-title":"24\/7\/365 in-house radiologist coverage","volume":"21","author":"Collins","year":"2014","journal-title":"Acad Radiol"},{"issue":"1","key":"10.1016\/j.acap.2026.103457_bib21","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4300\/JGME-D-09-00056.1","article-title":"The effect of overnight in-house attending coverage on perceptions of care and education on a general medical service","volume":"2","author":"Trowbridge","year":"2010","journal-title":"J Grad Med Educ"},{"issue":"2","key":"10.1016\/j.acap.2026.103457_bib22","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.joms.2012.05.006","article-title":"Chief resident case experience and autonomy are associated with resident confidence and future practice plans","volume":"71","author":"Fillmore","year":"2013","journal-title":"J Oral Maxillofac Surg"},{"issue":"4","key":"10.1016\/j.acap.2026.103457_bib23","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.jamcollsurg.2014.04.019","article-title":"Entrustment of general surgery residents in the operating room: factors contributing to provision of resident autonomy","volume":"219","author":"Teman","year":"2014","journal-title":"J Am Coll Surg"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib24","first-page":"2017","article-title":"A mixed-methods exploration of the developmental trajectory of autonomous motivation in graduate medical learners","volume":"31","author":"Hansen","year":"2021","journal-title":"MedSciEduc"},{"issue":"2","key":"10.1016\/j.acap.2026.103457_bib25","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1053\/j.semvascsurg.2025.04.001","article-title":"Autonomy, entrustment, self-efficacy, and decision-making: the current state of training independent surgeons","volume":"38","author":"Kariya","year":"2025","journal-title":"Semin Vasc Surg"},{"issue":"3","key":"10.1016\/j.acap.2026.103457_bib26","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.athoracsur.2017.05.034","article-title":"Resident autonomy in the operating room: expectations versus reality","volume":"104","author":"Meyerson","year":"2017","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib27","doi-asserted-by":"crossref","first-page":"e193","DOI":"10.1016\/j.jsurg.2015.06.002","article-title":"How do Perceptions of autonomy differ in general surgery training between faculty, senior residents, hospital administrators, and the general public? a multi-institutional study","volume":"72","author":"Kempenich","year":"2015","journal-title":"J Surg Educ"},{"issue":"11","key":"10.1016\/j.acap.2026.103457_bib28","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/medu.14542","article-title":"Longitudinal qualitative research in medical education: time to conceptualise time","volume":"55","author":"Balmer","year":"2021","journal-title":"Med Educ"},{"issue":"6","key":"10.1016\/j.acap.2026.103457_bib29","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.acap.2019.05.003","article-title":"Factors and behaviors related to the promotion of pediatric hospital medicine fellow autonomy: a qualitative study of faculty","volume":"19","author":"Maniscalco","year":"2019","journal-title":"Acad Pediatr"},{"key":"10.1016\/j.acap.2026.103457_bib30","unstructured":"Dedoose Version 9.0.107. Cloud application for managing, analyzing, and presenting qualitative and mixed method research data. Published online 2023. www.dedoose.com."},{"key":"10.1016\/j.acap.2026.103457_bib31","series-title":"The Craft of Qualitative Longitudinal Research","author":"Neale","year":"2021"},{"issue":"10","key":"10.1016\/j.acap.2026.103457_bib32","doi-asserted-by":"crossref","first-page":"e218","DOI":"10.1542\/hpeds.2021-005971","article-title":"Flying solo: effectiveness of attendingless family-centered rounds on improving resident autonomy","volume":"11","author":"Jain","year":"2021","journal-title":"Hosp Pediatr"},{"issue":"11S","key":"10.1016\/j.acap.2026.103457_bib33","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1097\/ACM.0000000000003645","article-title":"Righting the autonomy-supervision pendulum: understanding the impact of independent rounds on medical students, residents, and faculty","volume":"95","author":"Moriarty","year":"2020","journal-title":"Acad Med"},{"issue":"7","key":"10.1016\/j.acap.2026.103457_bib34","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.acap.2016.05.149","article-title":"Ward rounds with or without an attending physician: how interns learn most successfully","volume":"16","author":"Seltz","year":"2016","journal-title":"Acad Pediatr"},{"issue":"7","key":"10.1016\/j.acap.2026.103457_bib35","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1001\/jamainternmed.2018.1244","article-title":"Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial","volume":"178","author":"Finn","year":"2018","journal-title":"JAMA Intern Med"}],"container-title":["Academic Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1876285926002391?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1876285926002391?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:07:44Z","timestamp":1793326064000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1876285926002391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,11]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["S1876285926002391"],"URL":"https:\/\/doi.org\/10.1016\/j.acap.2026.103457","relation":{},"ISSN":["1876-2859"],"issn-type":[{"value":"1876-2859","type":"print"}],"subject":[],"published":{"date-parts":[[2026,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Evolving Conceptualizations of Autonomy: A Longitudinal Study of Pediatric Hospital Medicine Fellows into Attending Practice","name":"articletitle","label":"Article Title"},{"value":"Academic Pediatrics","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.acap.2026.103457","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Copyright \u00a9 2026 by Academic Pediatric Association All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"103457"}}