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Abstract

Background: Clinical supervision is crucial in postgraduate surgical education, where balancing resident autonomy with patient safety is essential. While the development of autonomy is widely discussed in medical education, there is limited understanding of how supervision shapes this process in periodontic surgical education. Objective: This dissertation aims to explore the processes of supervision and autonomy development in periodontics surgical education by generating substantive theories that explain how supervision is performed and how resident autonomy evolves over time. Methods: A grounded theory method, following the approach of Strauss and Corbin, was used to develop substantive theories based on empirical data. Data collection included semi-structured interviews with eight instructors and seven residents across different program stages in an academic institution. Theoretical sampling guided participant selection, allowing refinement of emerging categories to be developed and refined through constant comparison. Memos and diagrams were used to track concept development, explore relationships between categories, and ensure coherence in the construction of theory. To ensure credibility, member checking was conducted in conjunction with data triangulation, incorporating multiple stakeholders’ perspectives. Saturation was reached when no new concepts emerged, confirming the robustness of the developed frameworks. Findings: Two substantive theories emerged from this study. Adaptive Reasoning Mentorship explains the instructors' decision-making processes during supervision as responsive adjustments made in real-time. It illustrates how they adapt their approach based on their assessment of residents’ needs, patient considerations, and situational demands, reflecting on their experiences and expectations. Conditioned Relational Autonomy reconceptualizes autonomy as a relational, context-dependent construct that facilitates learning, rather than an individual achievement. This theory posits that autonomy develops through ongoing interactions between residents and instructors and is shaped by contextual influences. In this context, autonomy is negotiated through trust, prior experiences, residents’ demonstrated accountability, and instructors' interpretations of their educational and clinical responsibilities. Conclusion: The findings expose the complexity of supervision in periodontics surgical education and emphasize that autonomy is not a fixed state but rather a negotiated and context-dependent progression. These insights contribute to the broader discourse on medical education and offer practical implications for improving supervisory approaches in surgical education.