Academic medicine : journal of the Association of American Medical Colleges
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To identify and interpret differences between resident and faculty perceptions of resident autonomy and of faculty support of resident autonomy. ⋯ Faculty and residents had discordant perceptions of resident autonomy and of faculty support for resident autonomy. When faculty restrict the independence of "passive" residents whose competence they question, residents may receive fewer opportunities for active learning. Strategies that support autonomy, such as scaffolding, may help residents gain confidence and competence, enhance residents' relatedness to team members and supervisors, and help programs adapt to accreditation requirements to foster residents' growth in independence.
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Competency-based medical education (CBME) places a premium on both educational and clinical outcomes. The Milestones component of the Next Accreditation System represents a fundamental change in medical education in the United States and is part of the drive to realize the full promise of CBME. The Milestones framework provides a descriptive blueprint in each specialty to guide curriculum development and assessment practices. ⋯ In this Commentary, the author explores these challenges, addressing the concerns raised by Williams and colleagues in their Commentary. Meeting the assessment challenges of the Milestones will require a renewed commitment from institutions to meet the profession's "special obligations" to patients and learners. All stakeholders in graduate medical education must commit to a professional system of self-regulation to prepare highly competent physicians to fulfill this social contract.
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The Alliance for Academic Internal Medicine charged its Education Redesign Committee with the task of assisting internal medicine residency program directors in meeting the challenges of competency-based assessment that were part of the Accreditation Council for Graduate Medical Education's (ACGME's) Next Accreditation System. ⋯ These EPAs are intended to serve as a starting point or guide for program directors to begin developing meaningful, work-based assessments that inform the evaluation of residents' competence.
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To test the hypotheses that medical students recognized by peers as the most positive social influencers would score (1) high on measures of engaging personality attributes that are conducive to relationship building (empathy, sociability, activity, self-esteem), and (2) low on disengaging personality attributes that are detrimental to interpersonal relationships (loneliness, neuroticism, aggression-hostility, impulsive sensation seeking). ⋯ The research hypotheses were partially confirmed. Positive social influencers appear to possess personality attributes conducive to relationship building, which is an important feature of effective leadership. The findings have implications for identifying and training potential leaders in medicine.
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Many graduate medical education (GME) programs have started to consider and adopt entrustable professional activities (EPAs) in their competency frameworks. Do EPAs also have a place in undergraduate medical education (UME)? In this Perspective article, the authors discuss arguments in favor of the use of EPAs in UME. A competency framework that aligns UME and GME outcome expectations would allow for better integration across the educational continuum. ⋯ UME EPAs would be defined as essential health care activities with which one would expect to entrust a resident at the beginning of residency to perform without direct supervision. Finally, the authors recommend a refinement and expansion of the entrustment and supervision scale previously developed for GME to better incorporate the supervision expectations for UME learners. They suggest that EPAs could be operationalized for UME if UME-specific EPAs were developed and the entrustment scale were expanded.