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Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs
Journal of Educational Evaluation for Health Professions Pub Date : 2020-04-20 , DOI: 10.3352/jeehp.2020.17.11
Jason Lai 1 , Benjamin Holden Schnapp 1 , David Simon Tillman 1 , Mary Westergaard 1 , Jamie Hess 1 , Aaron Kraut 1
Affiliation  

Purpose The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees. Methods We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried. Results We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time. Conclusion The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

中文翻译:

在美国急诊医学住院医师计划中使用分级责任和共同委托考虑

目的研究生医学教育认证委员会(ACGME)要求所有住院医师课程都应随着居民通过培训(称为分级责任)的发展而提供越来越多的自治权。但是,关于如何在实践中实施分级责任的指导很少,而目前在急诊医学(EM)中如何实施分级责任的文献也很少。我们试图确定EM居住计划如何在各种活动中应用分级责任,并确定哪些考虑因素对向学员提供额外责任至关重要。方法我们使用23个问题调查对EM居住计划进行了横断面研究,该调查通过电子邮件发送给162位ACGME认可的EM计划负责人。询问了七个不同的实践领域。结果我们收到91份回复(56。2%的回复率)。在所有实践领域中,除了管理重症医学患者外,分级责任的使用超过了所调查计划的50%。当应用分级责任制时,研究生年(PGY)级别在80.9%到100.0%的时间内被评为“非常重要”或“非常重要”。结论大多数EM居住计划都在大多数实践领域中实施分级责任制。当围绕分级责任做出决策时,程序仍然严重依赖于基于时间的PGY级别模型来确定晋升。研究生年(PGY)等级在80.9%到100.0%的时间内被评为“非常重要”或“非常重要”。结论大多数EM居住计划都在大多数实践领域中实施分级责任制。当围绕分级责任做出决策时,程序仍然严重依赖于基于时间的PGY级别模型来确定晋升。研究生年(PGY)等级在80.9%到100.0%的时间内被评为“非常重要”或“非常重要”。结论大多数EM居住计划都在大多数实践领域中实施分级责任制。当围绕分级责任做出决策时,程序仍然严重依赖于基于时间的PGY级别模型来确定晋升。
更新日期:2020-04-20
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