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BACKGROUND: Burnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life-a phenomenon we term "thriving." OBJECTIVE: To identify factors contributing to both career and life satisfaction through qualitative interviews. PARTICIPANTS: The subjects were primary care physicians. APPROACH: Qualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach. MAIN MEASURES: Personal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout. RESULTS: Thirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment. CONCLUSIONS: Several factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, s u c h a s h a v i n g v a l u e -o r i e n t e d b e l i e f s a n d inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed.

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ImportanceGaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency.ObjectiveTo assess progress in developing an entrustment process in the Core EPAs framework.Design, Setting, and ParticipantsIn this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database.InterventionsSchools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations.Main Outcomes and MeasuresOn an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded.ResultsFour participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of “ready for indirect supervision” increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs.Conclusions and RelevanceThese findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.

Introduction:The Accreditation Council for Graduate Medical Education's milestones require internal medicine residents to have competency in calling consults. Based on a literature review, we developed an Entrustable Professional Activity (EPA) to delineate the knowledge, skills, and attitudes required for a consultation request and, building on the EPA, implemented an assessment instrument to provide feedback to interns calling consultation requests and assess the quality of their consult questions and the level of supervision required in performing this milestone. Methods: Assessments were done on internal medicine inpatient teaching services. Consultation requests were performed by interns and observed by residents using the assessment instrument. Feedback was provided to the interns. Interns then completed a self-reflection instrument based on the feedback. Results: Twenty-six paired observations were collected over three 1-month rotations. There was a moderate positive correlation (r = .43) comparing resident and intern responses to how they felt about the intern's ability to make a consultation request. There was a strong positive correlation (r = .65) comparing resident opinion of how strong the intern's ability in calling a consult to how well the consult question used the PICO (patient, intervention, comparators, outcomes of interest) framework. Twenty-five out of 28 interns (89%) said they would make a change during their next consultation request due to feedback from their resident. Discussion: Our EPA-based assessment instrument provided an opportunity to give interns feedback and to assess the quality of the consultation requests they made.