Report of Colloquium II: The Theory and Practice of Graduate Medical Education—How Do We Know When We Have Made a “Good Doctor”?

Abstract

Participants of the second colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project considered 3 primary questions: What is a "good doctor"? How do we make one? and How do we know when we have made one? Experts from other countries and other medical specialties helped participants wrestle with these most basic questions. Participants emerged with a better feeling of the utility of different types of evaluations needed to determine resident competence. It was clear that the complexity of the task requires faculty education and development. Most important, it requires the ongoing commitment of all of pediatrics as we seek to link education directly to better health outcomes for children, adolescents, and young adults. Pediatrics 2009;123:S17-S21 U NCERTAINTIES SURROUNDING EVOLVING health care needs of children, pediatric workforce, and financial structure that permeated the first colloquium of the Residency Review and Redesign in Pediatrics (R 3 P) Project carried over into the second colloquium, entitled "The Theory and Practice of GME and Certification." 1 In addition, the transformation in medical education that began with the Accreditation Council of Graduate Medical Education (ACGME) Outcome Project 2 heralded another uncertainty: "Will this transformation create better doctors?" The ACGME has begun to redefine the "good doctor" by expanding the requirements for learning and assessment from traditional focus on patient care and medical knowledge to include application of knowledge and 4 additional competencies: interpersonal and communication skills; professionalism; practice-based learning and improvement; and systems-based practice. The latter two competencies embrace, respectively, concepts of reflection on practice with the intent of improvement and on ability to function within the context of the larger health care-delivery system. This transformation, along with evolving and emerging health needs of children and adolescents, has called current models of training and assessment into question. The pediatric community is not alone in this self-study; the American Board of Internal Medicine and the American Board of Family Medicine are raising similar questions. [3][4][5][6] In this article, we report on the theory and practice of graduate medical education (GME) by guiding the reader through the activities and content of the second R 3 P Project colloquium.The goals of the colloquium were articulated by Dr Helena Davies from the United Kingdom, the keynote speaker and an expert in workplace-based assessments. She challenged the group with 3 questions:1. What is a good doctor? Does the definition change with time and context? Will the good doctor of today have the same attributes and skills as the good doctor of tomorrow?2. How do we make a good doctor? Do current training paradigms prepare pediatricians to meet the challenges of our patients? Will we be able to adapt them to meet the emerging needs of tomorrow's children? Is training designed with the end in mind, that is, are ...

Report of Colloquium III: Challenges for Pediatric Graduate Medical Education and How to Meet Them—A Quality Improvement Approach to Innovation in Pediatric Graduate Medical Education

“…Develop skills in critical thinking, decision-making, assessment of evidence, and prioritization in evaluation and management of children, adolescents, or young adults with an unusual presentation of a common health problem or with a disorder of unknown origin. 11 Pediatric residency education needs to ensure a balance between experiences in which residents are members of teams caring for complex patients with experiences in which residents gain confidence when caring for less complex patients and confronting novel situations. Assess the 6 ACGME competencies by using valid and reliable measures.…”

Linking Process to Outcome: Are We Training Pediatricians to Meet Evolving Health Care Needs?

“…Various methods of measuring learning outcomes were reviewed by invited experts. 11 Participants of all 3 colloquia, especially in colloquium II, questioned the fundamental rationale of pediatric generalist education: exposure of all residents to the greatest possible breadth of knowledge and experience. First, this has become progressively difficult as knowledge and varieties of practice have increased.…”

“…11 It examined pediatric residency education in the context of general trends in medical education, none more important than the movement toward greater emphasis on outcomes and away from a focus on educational process (eg, number of months on a specific rotation). 29 The primacy of outcomes is exemplified by the commitment of the ACGME, 3 the American Board of Medical Specialties, 30 and others (eg, the Federation of State Medical Boards 31 ) to the 6 general competencies of patient care: medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal and communication skills.…”

“…Completion of what is intended to be only the first phase of an ongoing effort is anticipated in early 2009. In addition to this introductory article, the supplement consists of an article that provides historical context for the R 3 P Project, 9 articles that summarize each of the colloquia, [10][11][12] and articles that describe results of the surveys requested by the R 3 P Committee and Project Group, [13][14][15][16] along with a commentary, 17 an article that describes the likely consequences of maintenance of certification on residency education, 18 and an article that projects the likely long-term future of evolutionary change in pediatric graduate medical education. 19 The colloquium summaries document a dramatic change in thinking that occurred during the course of the project.…”

Qu’est-ce qu’un bon médecin ?

“…L'exigence déontologique qui s'applique à tout médecin enseignant est de promouvoir la formation de « bons médecins » [1] . Intuitivement, les qualités d'un « bon médecin » semblent nombreuses : efficacité, compétence, pédagogie, recherche, rapidité, écoute, disponibilité, prudence, etc.…”