Recently, medicine educators have shifted their approach to training fellows in order to identify when trainees are “ready for unsupervised practice” in the six core competencies: medical knowledge, patient care, interpersonal communication skills, professionalism, practice-based learning and improvement, and systems-based practice. With the development of milestones, the ACGME has provided lengthy definitions and examples of how these competencies can demonstrably achieved.
In a recent AJKD article by Yuan et al, a novel method of tracking the progress of individual trainees in achieving a Nephrology-specific competency milestone is developed. Using a retrospective chart audit, they identified quality indicators and tracked individual trainees’ progress in a General and Transplant Nephrology Outpatient Clinic (which is considered an “entrustable professional activity (EPA)”).
The chart audit tool allowed for documentation of deficiencies, and the opportunity to provide specific feedback to trainees, e.g., encouraging them when they employ appropriate testing and acknowledging when they make challenging diagnoses. They were also used by the educators to identify strengths and weaknesses, as well as areas that need further emphasis. As is expected, the aggregate deficiency rates declined as fellows advanced through their training, and confirmed that the more senior trainees had fewer deficiencies as compared to those in their early training years. Interestingly, there was some association demonstrated between the trainees’ chart audit performances and their performance on the In-Training Examination (ITE), particularly among the senior trainees.
This is a novel way by which a training program can document and evaluate milestone progress. I look forward to more novel ideas in the years to come from our nephrology educators.
Edgar Lerma, MD