Bibliographic record
Abstract
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]
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".