Academic medicine : journal of the Association of American Medical Colleges
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Good leadership is essential for optimal trauma team performance, and targeted training of leadership skills is necessary to achieve such leadership proficiency. To address the need for a taxonomy of leadership skills that specifies the skill components to be learned and the behaviors by which they can be assessed across the five phases of trauma care, the authors developed the Taxonomy of Trauma Leadership Skills (TTLS). ⋯ The TTLS provides a framework for teaching, learning, and assessing team leadership skills in trauma care and other complex, acute care situations.
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To address the long-standing challenge of meaningful trainee assessment, the authors reviewed and expanded on the Accountable Assessment for Quality Care and Supervision (AAQCS) equation. The equation proposes that care quality is the product of the interaction between trainee performance (measured by workplace assessment) and supervision (required level of intervention to ensure care quality) in the context of the environment where the care occurs: Trainee performance × Appropriate supervision = Safe, effective patient-centered care. ⋯ Because the unit of measure for an EPA is the outcome of whether the trainee can safely and effectively perform the professional activity without supervision, the proposed unifying framework directly aligns with the dependent variable in the AAQCS equation: care quality. The value of applying a unifying framework that integrates EPAs, competencies, and milestones to the AAQCS equation in the clinical learning environment lies in its ability to provide supervisors with a shared mental model of performance expectations for trainees, reducing unwanted variability and improving assessment accuracy; guidance for aligning performance milestones of trainees with the needed level of supervisor intervention to ensure care quality; and substrate for specific feedback to improve the trainee's professional development as a way to ensure future care quality.
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The decision to trust a medical trainee with the critical responsibility to care for a patient is fundamental to clinical training. When carefully and deliberately made, such decisions can serve as significant stimuli for learning and also shape the assessment of trainees. Holding back entrustment decisions too much may hamper the trainee's development toward unsupervised practice. ⋯ Anticipating a decision to grant autonomy at a designated level of supervision appears to align better with health care practice than do most current assessment practices. The authors distinguish different modes of trust and entrustment decisions and elaborate five categories, each with related factors, that determine when decisions to trust trainees are made: the trainee, supervisor, situation, task, and the relationship between trainee and supervisor. The authors' aim in this article is to lay a theoretical foundation for a new approach to workplace training and assessment.
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Comment
Recruiting Quarterbacks: Strategies for Revitalizing Training in Primary Care Internal Medicine.
Current U. S. primary care workforce shortages and trainees' declining interest in primary care residency training, especially regarding primary care internal medicine, have many parallels with circumstances in the early 1970s, when modern adult primary care first emerged. Rediscovery of the lessons learned and the solutions developed at that time and applying them to the current situation have the potential to help engage a new generation of young physicians in the primary care mission. ⋯ Strategies for addressing the challenges of primary care practice and improving learner attitudes toward the field are discussed. The author suggests that primary care physicians should be likened to "quarterbacks" rather than "gatekeepers" or "providers" to underscore the intensity of training, level of responsibility, degree of professionalism, and amount of compensation required for this profession. The advent of multidisciplinary team practice, modern health information technology, and fundamental payment reform promises to dramatically alter the picture of primary care, restoring its standing as one of the best job descriptions in medicine.