Notice bibliographique
Résumé
Sir: The recent article by Bancroft et al. (Plast Reconstr Surg. 2008;121:441e–448e) describes teaching and evaluating the “core competencies” in plastic surgery residencies. As described in the article, the Accreditation Council for Graduate Medical Education began to focus on the outcomes of residency programs in producing well-trained residents. The six core competencies are becoming the basis for teaching up and down the medical hierarchy, from the recertification process for physicians to remain on staff at hospitals to the training of medical students. The desire to continue to improve the process of graduate medical education is real. The six core competencies, however, are at best an illogical division of the body of knowledge of medicine. At worst, the competencies are an unproven distraction that sucks out the teaching life-blood of those who wish to educate the next generation of physicians. If the competencies are so logical, why do I have to look up the six categories each time I type them for the residents? Why do the competencies only come up in classrooms at the beginning of the year and around the time of site visits? In this era of evidence-based medicine, where is there even a shred of evidence that the teaching of medicine or surgery by means of the six competencies has improved the education process? The competencies particularly fail the surgical specialties. In the article by Bancroft et al., there is not one mention of how to tie a knot. There is no mention of mentorship or of what it takes to be a surgical apprentice. Not one Accreditation Council for Graduate Medical Education newsletter writes of the time spent between a master and a trainee or of the dedication the master must exhibit to continually teach. The critical flaw in the competency model of education for the surgical disciplines is its blindness to the size of the groups. For large nonsurgical residencies, it truly does take a village. There are too many residents and too many teachers, and the process of evaluation and outcomes may indeed be ideal to assess the education process. It is a program involving consensus and group action. Surgery requires the opposite of what works for the village. There is only one person making decisions at a given moment in the operating room, and only one person who needs to wake up to go to the emergency room to treat a patient. For surgery, with one to three residents per year and with long exposures of a single attending physician to a single resident, the evaluation process seems superfluous. Of 30 trainees and attending physicians at Northwestern, using an Internet-based system and with over 500 possible chances to write comments, only a handful of written remarks were made. The 360-degree evaluations provided even less information. The evaluators, left to their own devices, used the quicker “check-off box” to create numeric scores. On the surface, the Accreditation Council for Graduate Medical Education and the Residency Review Committee will be pleased. The process is deemed flawless, because everyone evaluates everyone else and everyone receives feedback. However, in this case, the competencies did not improve our residency program. It is neither the competencies nor compliance with the exhaustive evaluation process that generates results: it is quality time spent between master and apprentice. This Letter to the Editor will not stop the competency steamship. However, it is time that someone stands up to say that the emperor has no clothes. Gregory A. Dumanian, M.D. Division of Plastic Surgery Northwestern Memorial Hospital 19-250 Div. Plast. Surg. 675 North St. Clair Street Chicago, Ill. 60611-4807 [email protected]
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».