Trusting Graduates to Enter Residency: What Does It Take?

Cate, Olle ten

doi:10.4300/jgme-d-13-00436.1

Cited by 51 publications

(19 citation statements)

References 12 publications

(8 reference statements)

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“…The underlying foundation of medical training is that residents receive appropriate, graded responsibility with decreased supervision leading to independent practice when they graduate 6,7. To complement the Accreditation Council for Graduate Medical Education (ACGME) assessment of competencies, ten Cate and others have proposed entrustable professional activities (EPA) 8.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Entrustment and Autonomy in Emergency Medicine: “How much rope do I give them?”

Santen

Wolff

Saxon

et al. 2018

WestJEM

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IntroductionDuring residency, the faculty’s role is to provide supervision while granting the trainee autonomy. This concept is termed entrustment. The goal is appropriate progression from supervision to autonomy while decreasing oversight as residents train. The objective of this study was to better understand the factors affecting the degree of autonomy or supervision faculty choose to provide residents.MethodsThis was a qualitative study of resident and faculty perceptions. We conducted two faculty and two resident focus groups. We then transcribed the transcripts of the audiotaped discussions and coded them using grounded theory.ResultsAnalysis of the transcripts yielded four major factors affecting entrustment of residents.Patient Factors included the acuity of the patient, sociomedical issues of patient/family, and complexity of risk with patient or procedure. For example, “sometimes there are families and patients who are exceedingly difficult that immediately sort of force me [to allow less autonomy].”Environmental Factors included patient volume and systems protocols (i.e., trauma). “If you’re very busy and you have a resident that you already trust, you will give them more rope because you’re trying to juggle more balls.”Resident Factors included the year of training, resident performance, clinical direct observation, and patient presentations. “But if you have a resident that you do not trust […] I tell them you’re going to do this, this, this, this, this.”Faculty Factors included confidence in his/her own practice, risk-averse attitude, degree of ownership of the patient, commitment to education, and personality (e.g., micro-manager). Significant variability in entrustment by faculty existed, from being “micromanagers” to not seeing the patients. One resident noted: “There are some attendings, no matter how much they like you and how much you’ve worked with them, they’re always going to be in your face in the trauma bay. And there’s some attendings that are going to be ghosts.”ConclusionMultiple factors affect the amount of autonomy and entrustment given to residents and their level of supervision by faculty, leading to wide variability in entrustment. In the end, regardless of resident, patient, or environment, some faculty are more likely to entrust than others.

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Section: Introductionmentioning

confidence: 99%

Factors Affecting Entrustment and Autonomy in Emergency Medicine: “How much rope do I give them?”

Santen

Wolff

Saxon

et al. 2018

WestJEM

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“…Enabling students to transfer their anatomical knowledge from the classroom to the clinical settings is one of the biggest challenges for contemporary anatomists. One of the core entrustable professional activities expected out of a graduate medical student is to prioritize a differential diagnosis following a clinical encounter [ 24 ]. The key aim for designing the clinico-anatomical case vignette session is to structure the clinical reasoning skills right from the pre-clinical phase of medical education.…”

Section: Discussionmentioning

confidence: 99%

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study

et al. 2020

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The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The ‘ideal’ blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning (‘serial cue’ approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student’s t -test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions ( P <0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

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“…This method first became known for its use in the area of post-graduate education; since 2013 it has also appeared in undergraduate medical education [167], [168]. The integration of theoretical and practical knowledge to solve complex problems is assessed (e.g.…”

Section: Discussionmentioning

confidence: 99%