Academic medicine : journal of the Association of American Medical Colleges
-
Editorial Comment
Using self-determination theory to improve residency training: learning to make omelets without breaking eggs.
An inherent tension exists in clinical training between supervising learners to ensure quality and patient safety, and allowing learners to practice independently to gain experience. In this issue of Academic Medicine, Biondi and colleagues discuss this tension, highlighting the disconnect between faculty and resident perceptions of autonomous practice for housestaff. They report that each group perceives itself as more competent in its role than does the other group. ⋯ To optimize the balance between autonomy and supervision, this Commentary's author proposes the use of "scaffolding," a construct from developmental psychology. In the scaffolding model, the role of teachers is to support the learner's development and to provide support structures to help the learner get to the next stage of entrustment and competence. Achieving a balance is essential to providing the best patient care now and in the future.
-
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.
-
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.
-
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.
-
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.