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Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs

Lai Jason, Schnapp Benjamin H., Tillman David S., Westergaard Mary, Hess Jamie, Kraut Aaron S.,
소속 상세정보
 ( Lai Jason ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine
 ( Schnapp Benjamin H. ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine
 ( Tillman David S. ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine
 ( Westergaard Mary ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine
 ( Hess Jamie ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine
 ( Kraut Aaron S. ) - University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine

Abstract


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 emergency medicine (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.

키워드

Cross-sectional studies; Emergency medicine; Internship and residency; Medical education; United States of America

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