Defining and Assessing the 21st-Century Physician in Training

Abstract

W e are experiencing a paradigm shift in medical education. Education has moved away from using Btime^as a determinant of learner readiness to advance to the next stage and ultimately onto independent practice, to the current competency-based paradigm that focuses on a learner's mastery of specific professional activities as a measure of their fitness for unsupervised practice. This approach creates opportunities for more individualized, developmental-based learning, and how we define competency will drive curriculum development and assessment. For example, defining the specific competencies needed to provide high-quality care may identify gaps in existing curricula. Competency-based education lends itself to Bassessment for learning^in which learners utilize regular feedback from multiple sources to improve performance in a set of defined skills and behaviors along a developmental continuum.1 Structures that support this model include clearly described competencies that link entrustable professional activities (EPAs) (which represent the work that competent physicians perform when synthesizing and contextualizing knowledge and information to care for patients) to learning experiences that occur in authentic clinical environments with opportunities for individualized assessment coupled with meaningful real-time feedback.2 To achieve the full benefit of competency-based education, learners and teachers must have a shared frame of reference around the expectations required to demonstrate competency, and faculty must be skilled assessors who are capable of making valid and reliable decisions regarding entrustment. The tasks for today's educators are to define the competencies that appropriately describe the 21st-century physician most capable of providing high-quality care in an increasingly complex system, and then to design methods that accurately and reliably assess those competencies in a way that promotes deep and meaningful learning among physician trainees. The articles in this issue by Hauer et al. 4 and Hemmer et al. 5 outline steps for achieving these tasks. Hauer and colleagues provide a roadmap that uses a rigorous approach to defining EPAs for medical students. They employed a holistic approach and engaged stakeholders to build a common framework for shared understanding of a competent graduate. Hemmer and colleagues demonstrate that faculty development involving timely and specific descriptions of learner behaviors based on a shared frame of reference improved validity and reliability of medical student assessments. These two processes are necessary components for assessment for learning. Faculty responsible for guiding students through their professional development must have both a shared understanding of the relevant behaviors and the ability to provide specific feedback about a student's trajectory to aid their advancement. Hauer et al. set out to define EPAs for medical students, starting from a community-based perspective, and then defining the health needs of the communities their graduates wil...

Difficult Patient Encounters: Assessing Pediatric Residents' Communication Skills Training Needs

“…The resident request for “ less attendings stepping in to ‘help ’” noted in the free response section suggests that some residents want to be granted greater autonomy to more fully engage in these challenging conversations. Trainees may enter residency without having had much opportunity to lead or even observe challenging conversations, as was suggested by one incoming intern who stated that they would benefit from “ watching role models in difficult encounters (because as med students we were often told to stay out of the room in these situations) .” Faculty development is important for both providing trainees with feedback and making decisions about entrustability, especially in the context of competency-based medical education [ 28 ]. Developing a program where faculty directly observe and coach a group of residents and provide feedback has been shown to improve the resident perception of feedback quality; however, this may be somewhat time intensive, as one successful program required about 10% salary support for each faculty member coaching 10 residents [ 29 ].…”

Effectiveness of a supervisor training on quality of feedback to internal medicine residents: a controlled longitudinal multicentre study

“…[3][4][5] Although residents consider narrative feedback helpful, they also express a need for more specific suggestions for improvement from their supervisors. 14 Furthermore, they desire greater supervisor involvement in synthesising feedback comments and integrating them into their practice. 15 Therefore, feedback training for clinical supervisors should focus on how they can help residents reflect on their performance regarding different competencies and define points for further improvement.…”

Zum Einfluss von Lern- und Prüfungsumgebung auf die Performance von Studierenden im Bereich Notfallmedizin

“…4 Eine verstärkte Praxisorientierung im Medizinstudium ist somit zwar allgemein gewünscht, teils bereits in Form von sog. Skillslabs implementiert 19 und es wird mittlerweile auch viel darüber diskutiert, mit welchem Set an Fertigkeiten die Absolventen der Zukunft nach dem Studium ausgestattet sein sollten, 20,21 allerdings wird es ein Mindestmaß an Standardisierung bundesweit wohl erst im Rahmen der zukünftigen Neuerungen der ÄApprO und der Staatsexamina geben. 21 Aktuell gibt es zur Überprüfung praktisch erlernter Fertigkeiten im Studium im Rahmen der staatlichen Examina nur das M3, die mündlich-praktische Prüfung, wobei Ausmaß und Prüfungsmodalität des praktischen Anteils nicht konkret definiert sind und somit der Ausgestaltung der jeweiligen Prüferkohorte anheimfallen (nach §15 der ÄApprO von 2002).…”