Sufficient Competence to Enter the Unsupervised Practice of Orthopaedics: What Is It, When Does It Occur, and Do We Know It When We See It? AOA Critical Issues.
The goal of residency programs is to provide an educational venue with graduated responsibility and increasing levels of independence as preparation for entering the unsupervised practice of medicine. Surgical programs are required to both cultivate and convey skills pursuant to three fundamental domains: a sufficient fund of knowledge, technical competence in surgical procedures, and a degree of professionalism to enable ethical independent practice. Never before has the expectation that residency programs provide graduated responsibility in preparation for entering the unsupervised practice of medicine been so clearly articulated as it has by Nasca in the recent Accreditation Council for Graduate Medical Education (ACGME) work-hour guideline revisions. The Royal College of Physicians and Surgeons has provided similar guidance in Canada. Yet, as we progress further into the second decade of work-hour restrictions, it is unclear that we have adequately defined or can recognize the critical end points essential to trainee competency. What is clear is that we must achieve these end points in a manner different from that prior to the introduction of work-hour restrictions. We present the current state of thinking from North America and contrast this with the evolving medical educational process in the United Kingdom.
Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425. E-mail address: pellegvd@musc.edu.
Vincent D
VD
Pellegrini
Division of Orthopaedics, Department of Surgery, University of Toronto, 600 University Avenue, Suite 476G, Toronto, ON M5G 1X5, Canada.
Peter C
PC
Ferguson
Centre for Medical Education, Faculty of Medicine, McGill University, Lady Meredith House, 2nd floor, 1110 Pine Avenue West, Montreal, QC H3A 1A3, Canada.
Richard
R
Cruess
Centre for Medical Education, Faculty of Medicine, McGill University, Lady Meredith House, 2nd floor, 1110 Pine Avenue West, Montreal, QC H3A 1A3, Canada.
Sylvia
S
Cruess
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
Timothy W R
TW
Briggs
D000068:Accreditation / Q000592:standards; D002170:Canada; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D009985:Orthopedics / Q000193:education / Q000592:standards*; D006113:United Kingdom; D014481:United States