Supervision, Entrustment and Autonomy in Family Medicine Residency: A Scoping Review of Supervisory Models and Progressive Responsibility

Resumen

Background: In Family Medicine residency, supervision is to balance patient safety with progressive autonomy. Yet “supervision intensity” is rarely treated as an explicit analytic construct, and the literature remains fragmented across structural, relational, and competency-based framings.

Objective: To map how supervision intensity and supervisory structures are conceptualized in Family Medicine residency training, and how these conceptualizations are linked to entrustment, progressive responsibility, and professional autonomy.

Methods: A scoping review was conducted following PRISMA-ScR guidance and Joanna Briggs Institute recommendations. Searches were performed on February 6, 2026 in PubMed/MEDLINE and LILACS; ERIC was initially explored but not retained due to limited alignment with physician residency training in Family Medicine. Eligible sources included empirical studies (qualitative, quantitative, or mixed-methods) and conceptually oriented papers that explicitly described supervision structures and autonomy-related constructs within Family Medicine residency contexts (2015–2025; English, Portuguese, or Spanish). Two reviewers independently screened titles/abstracts and assessed full texts. Data were charted iteratively and synthesized narratively through conceptual mapping.

Results: From 82 records identified, 11 duplicates were removed and 71 records were screened. Twenty-one full texts were assessed; six were excluded for not addressing supervisory structures or autonomy-related constructs. Fifteen studies were included in the final synthesis. Three dominant conceptual logics were mapped: (1) competency-based entrustment, operationalizing autonomy through structured assessment frameworks (e.g., EPA-linked readiness); (2) relational supervision, framing autonomy as negotiated through trust, identity formation, and supervisory behaviors; and (3) organizational and contextual models, in which regulation, workload, and training design shape how responsibility is distributed and experienced.

Conclusions: Supervision intensity in Family Medicine residency is conceptualized through heterogeneous logics that range from formal entrustment metrics to relational and organizational framings. Conceptualizing supervision intensity as an explicit construct may improve theoretical coherence, enable cross-study comparison, and inform the design of training models that support progressive autonomy.