We concluded that catatonia is under recognized and undertreated among children and adolescents receiving psychiatric treatment.

ImportanceUnderstanding how to translate workplace-based assessment (WBA) ratings into metrics that communicate the ability of a surgeon to perform a procedure would represent a critical advancement in graduate medical education.ObjectiveTo evaluate the association between past and future performance in a comprehensive assessment system for the purpose of assessing point-in-time competence among general surgery trainees.Design, Setting, and ParticipantsThis case series included WBA ratings from September 2015 to September 2021 from the WBA system of the Society for Improving Medical Professional Learning (SIMPL) for all general surgery residents who were provided a rating following an operative performance across 70 programs in the US. The study included ratings for 2605 trainees from 1884 attending surgeon raters. Analyses were conducted between September 2021 and December 2021 using bayesian generalized linear mixed-effects models and marginal predicted probabilities.ExposuresLongitudinal SIMPL ratings.Main Outcomes and MeasuresPerformance expectations for 193 unique general surgery procedures based on an individual trainee’s prior successful ratings for a procedure, clinical year of training, and month of the academic year.ResultsUsing 63 248 SIMPL ratings, the association between prior and future performance was positive (β, 0.13; 95% credible interval [CrI], 0.12-0.15). The largest source of variation was postgraduate year (α, 3.15; 95% CrI, 1.66-6.03), with rater (α, 1.69; 95% CrI, 1.60-1.78), procedure (α, 1.35; 95% CrI, 1.22-1.51), case complexity (α, 1.30; 95% CrI, 0.42-3.66), and trainee (α, 0.99; 95% CrI, 0.94-1.04) accounting for significant variation in practice ready ratings. After marginalizing overcomplexity and trainee and holding rater constant, mean predicted probabilities had strong overall discrimination (area under the receiver operating characteristic curve, 0.81) and were well calibrated.Conclusions and RelevanceIn this study, prior performance was associated with future performance. This association, combined with an overall modeling strategy that accounted for various facets of an assessment task, may offer a strategy for quantifying competence as performance expectations.

Competency‐Based Education (CBE) programs have developed differently within higher education and medical education systems, yet both systems face challenges when bridging the gap between theory and practice. Both medicine and higher education face the challenge of adapting CBE programs for learners who begin the program with different configurations of knowledge and skillsets and learn at different rates. Additional challenges include, but are not limited to standard setting, time variability within programs for student learning, defining competencies, and training faculty to develop and assess CBE programs. This article argues there is much higher education programs can learn about defining competencies, assessing performance, and curriculum design by understanding how CBE is implemented in medical education. We also provide an overview of how CBE in medical education (CBE‐ME) has evolved compared to CBE in higher education (CBE‐HE), including examples of how medical education has addressed defining competency issues, assessing competence, and standard setting.

Increased prescribing of opioids has been associated with an epidemic of nonmedical prescription opioid use in the United States; adolescents and young adults are particularly vulnerable to opioid misuse. The role of physicians as health care providers, educators, and confidants for their adolescent patients equips them to intervene in adolescent opioid misuse. The authors advocate for improving the education of physicians and residents regarding opioid use and misuse among adolescents. To achieve this, we can require residency education that includes opioid misuse and appropriate prescribing, widely disseminate existing resources on management of pain and opioid misuse, and develop pain management and addiction mentorship programs.

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