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Invited Commentary
July 2018

Optimizing the Balance Between Supervision and Autonomy in Training

Author Affiliations
  • 1Internal Medicine Residency Program, National Capital Consortium, Bethesda, Maryland
  • 2Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
  • 3Department of Medicine, General Internal Medicine Service, Walter Reed National Military Medical Center, Bethesda, Maryland
JAMA Intern Med. 2018;178(7):959-960. doi:10.1001/jamainternmed.2018.1250

Graduate medical education continues to evolve. The current epoch has focused heavily on maturation of our systems of assessment, redefining our role in health care teams, and increased efforts to improve quality of care, as well as patient and trainee safety. It is imperative that we remain mindful of the social contract between society and the medical profession, and by extension, the contract between patients and physicians as trainees, as a guiding frame of reference. In this contract, what is the ideal balance between supervision and trainee autonomy? In the path to independent practice, there are a myriad of competing factors (eg, cost, patient safety, continuity, learning efficiency, work hour restrictions) that affect this balance.1,2 As graduate medical education continues to adopt a competency-based medical education framework, whereby thresholds of advancement are determined by reliable performance rather than time-based milestones, there are even further concerns about the impact on patient safety and quality, as well as the adequacy of trainee education.

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