Progressive Independence in Clinical Training: Perspectives of a National, Multispecialty Panel of Residents and Fellows

Abstract

Background Progressive independence in patient care activities is imperative for residents' readiness for practice and patient safety of those cared for by graduates of residency programs. However, establishing a standardized system of progressive independence is an ongoing challenge in graduate medical education.

Rigor and Support in Racialized Learning Environments: The Case of Graduate Education

“…Unlike apprenticeship, which connotes close engagement in practical activities for which one is being trained, scaffolding enables students to work within the challenging space between their current and desired skills and abilities (what Vygotsky coined the zone of proximal development). As in professional education programs, doctoral students engage their subject matter with “progressive independence” (Kennedy, Regehr, Baker, & Lingard, ) or “graduated responsibility” (Franzone et al., ). Indeed, perhaps part of what makes doctoral education so notoriously challenging is the particular combination of learning expectations placed upon students: to increasingly operate in the mode of cognitive complexity that research demands, on topics that lie at the edge of current disciplinary boundaries, while reducing reliance on familiar supports of their professors or peers.…”

Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs

“…Previous work has attempted to elucidate the ideal system for implementing graded responsibility within residency training through panel discussions and iterative theme generation [4]. Although structured discussions yielded broad concepts and ideals that could promote graded responsibility, the panel was not instructed to enumerate specific practices that would exemplify the consensus themes that it put forward, and its findings and conclusions are not specific to emergency medicine (EM) residency programs.…”

Introductory Chapter: A Quest to Transform Graduate Medical Education into a Seamless Journey toward Practice Readiness

“…Graduate medical education (GME) represents the transition between the traditionally understood world of "undergraduate education," including the medical school, and the realm of fully professional engagement within a medical or surgical specialty [1,2]. Due to the relative shielding of trainees from full spectrum exposure to "real-life practice" environments and responsibilities, important gaps in readiness exist [3,4]. In response, residency and fellowship programs are undergoing significant transformation to more effectively prepare graduates to meet the expectations of a busy, modern day clinical practice [2,5].…”