From the Editors
Many of the articles in this issue focus on competency-based education and the roll-out of the Milestones in the 7 specialties entering the Next Accreditation System in July 2013.
In the editorial section, ten Cate discusses the power of language and the value of entrustable professional activities (EPAs) in competency-based education (pp. 6). In a second editorial Magee and colleagues present the second in a series of articles on survey design, focusing on the application of a survey design framework to assess the integration of 2 internal medicine programs (pp. 1).
Cianciolo and Kegg discuss the behavioral specifications for entrustment to give residents added responsibility and autonomy in patient care (pp. 10). Hurtubise et al describe effective use of video triggers to engage learners (pp. 13).
A review addresses the evidence and proposes new steps in refining duty hour limits in surgical specialties (Fabricant et al, pp. 19).
Milestones and EPAs
Swing and representatives for the milestones workgroups for specialties entering the Next Accreditation System in 2013 discuss milestone development (pp. 98). A supplement to the issue features the initial milestones for these specialties. Nabors and colleagues report on early work to assess the operational attributes of the internal medicine milestones (pp. 130). Articles that focus on EPAs include work from the Netherlands that identifies attributes of competence that allows supervisors to make entrustment decisions (Wijnen-Meijer and colleagues, pp. 46); and use of EPAs in internal medicine education (Hauer et al, pp. 54) and family medicine (Shaughnessy et al, pp. 112). A Rip Out article by ten Cate summarizes key elements of EPAs (pp. 157).
Research and Educational Innovation
Mullan, Shapiro, and colleagues discuss interns' experiences with disruptive behavior (pp. 25). Wallace et al describe a community-learning experience that increased residents' knowledge about health disparities (pp. 119). A commentary by Wieland discusses poverty, health, and graduate medical education (pp. 163).
Peterson and colleagues research family medicine graduates' beliefs about duty hour limits, supervision, and patient safety (pp. 31). Mann et al found that pediatrics residents showed a high degree of patient-centeredness that was not increased by a targeted intervention (pp. 36). Lefebvre and colleague found that offering continuing medical education (CME) credit increases faculty attendance at resident conferences (pp. 41).
Riebschleger and Haftel report that pediatrics residents in remediation frequently have deficiencies in medical knowledge and patient care, with deficiencies in systems-based practice and practice-based learning and improvement less common (pp. 60). Nikels et al found that nonphysicians evaluating residents were most comfortable providing feedback on professional behaviors, with nurses also able to evaluate medical knowledge and clinical judgment (pp. 64). Bernabeo et al found completion of practice improvement modules by internal medicine residents resulted in sustainable patient care improvements (pp. 74). Donnelly et al surveyed internal medicine–pediatrics program directors on practice in transferring graduating residents' continuity patients (pp. 93), and Mittal and colleagues show the positive impact of family-centered rounds on education and quality of care (pp. 81).
Clark et al describe how an anesthesiology rotation improved residents' success in endotracheal intubation (pp. 70); Ben-Isaac and colleagues studied procedures performed by pediatrics graduates in general practice and discuss the educational implications (pp. 88); and Chu et al describe an e-learning curriculum that prepares interns for the transition to clinical anesthesiology (pp. 125). McCormick and colleagues present a promising approach that uses modeling of countermeasures to reduce resident fatigue (pp. 107).
Lobo et al describe use of iPads in resident education (pp. 142), and a commentary by Wu discusses the impact of smartphones and tablets on education and clinical work (pp. 161). Other brief reports describe education of referring physicians to decrease ophthalmology residents' at-home call (Nemani et al, pp. 138); the effect of a multidisciplinary diabetes clinic on resident knowledge and patient outcomes (Lo et al, pp. 145); and an intervention to improve intern handoffs (Shaughnessy et al pp. 150).
Spagnoletti et al discuss workshops as scholarship for clinician-educators (pp. 155); and Martin and Farnan present the SUPERB safety model for enhancing supervision in the inpatient settings (pp. 159).
An essay by Bennett uses a personal experience to overcome preconceived notions about patients (pp. 166).
ACGME News and Views
Robertson and Nestler describe a study to improve accreditation site visit reports for high-performing programs and foreshadow report changes anticipated in the Next Accreditation System (pp. 167).