Perspective: Beyond Counting Hours: The Importance of Supervision, Professionalism, Transitions of Care, and Workload in Residency Training
The medical education community's conversations about residents' duty hours have long focused solely on the number of those hours. In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted its most recent iteration of standards regarding duty hours. Those standards, as well as a 2008 Institute of Medicine report, look beyond the quantity of duty hours to address their quality as well. Indeed, the majority of the 2011 ACGME standards specify requirements for the qualitative components of residents' working and learning environments, including supervision of residents; professionalism, personal responsibility, and patient safety; transitions of care; and clinical responsibilities (including workload). The authors believe that focusing on these qualitative (rather than quantitative) components of the resident's working and learning environment provides the greatest promise for balancing patient care with resident education, thus optimizing the safety and effectiveness of both. For each of the four qualitative components that the authors discuss (enhancing supervision, nurturing professionalism and personal responsibility, ensuring safe transitions of care, and optimizing workloads and cognitive loads), they offer agendas for faculty development, educational program planning, and research. Thus, the authors call on the medical education community to expand its discussion beyond counting duty hours to focus on these critical issues that ensure quality resident education and patient care and to implement necessary strategies to address them.
Available from: Sheilla K Pinjani
- "Evaluating is part of supervising. It also means giving feedback on how well something is being done and interpreting that feedback  . "
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Resident attrition is a significant issue facing graduate surgical education, with broad implications for trainees, their families, educators, and society at large. Resident attrition is costly and often may represent a poor initial selection process, inadequate training in medical school, or insufficient feedback and mentoring while the resident is in the postgraduate program. Promoting an environment that encourages mentorship may be an important first step to help residents maximize their professional potential. The successful mentoring of surgical residents is crucial because the entire specialty depends on how today's residents face tomorrow's challenges.
resident; attrition; postgraduate medical education; mentor
Journal of Orthopaedics and Trauma 04/2014; 4. DOI:10.4303/jot/235814
Available from: PubMed Central
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As efforts to address patient safety (PS) in health professional (HP) education increase, it is important to understand new HPs’ perspectives on their own PS competence at entry to practice. This study examines the self-reported PS competence of newly registered nurses, pharmacists and physicians.
A cross-sectional survey of 4496 new graduates in medicine (1779), nursing (2196) and pharmacy (521) using the HP Education in PS Survey (H-PEPSS). The H-PEPSS measures HPs’ self-reported PS competence on six socio-cultural dimensions of PS, including culture, teamwork, communication, managing risk, responding to risk and understanding human factors. The H-PEPSS asks about confidence in PS learning in classroom and clinical settings.
All HP groups reported feeling more confident in the dimension of PS learning related to effective communication with patients and other providers. Greater confidence in PS learning was reported for learning experiences in the clinical setting compared with the class setting with one exception—nurses’ confidence in learning about working in teams with other HPs deteriorated as they moved from thinking about learning in the classroom setting to thinking about learning in the clinical setting.
Large-scale efforts are required to more deeply and consistently embed PS learning into HP education. However, efforts to embed PS learning in HP education seem to be hampered by deficiencies that persist in the culture of the clinical training environments in which we educate and acculturate new HPs.
BMJ quality & safety 11/2012; 22(2). DOI:10.1136/bmjqs-2012-001308 · 3.99 Impact Factor
Available from: onlinelibrary.wiley.com
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ABSTRACT: The 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM) addressed various issues, including that of ethics in medical education research for EM. Education research in EM is essential to patient care and safety, and with recent advances in simulation and the advent of the Milestones project, it will become even more vital. Education research in EM is guided by the same principles that guide the ethical conduct of all human subjects' research: respect for persons, beneficence, and justice. Regulatory provisions and widely accepted ethical standards provide a framework for research in EM education; however, special considerations exist for education research. To ensure patient and trainee safety and to maintain the integrity of new knowledge, ethical considerations should remain at the forefront of EM education research. For EM education researchers, recognition of the vulnerability of residents, medical students, and others as research subjects is paramount. This article fills an important gap by outlining the principles guiding education research in EM, exploring the ethical challenges and approaches to education research, and offering a framework and future directions for the ethical conduct of education research in EM.
Academic Emergency Medicine 12/2012; 19(12). DOI:10.1111/acem.12019 · 2.01 Impact Factor
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