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September 8, 2008

Graduate Medical Education in Ophthalmology: Moving From the Apprenticeship Model to Competency-Based Education

Arch Ophthalmol. 2008;126(9):1290-1291. doi:10.1001/archophthalmol.2008.3

Historically, graduate medical education in the United States has relied heavily on the apprenticeship model (ie, “see one, do one, teach one”). In this apprenticeship model, the “apprentice” (ie, the resident or fellow) serves under the guidance of an experienced faculty master. The model unfortunately has significant limitations that have driven calls for transformation to a more competency-based model of education. The transition will ideally better align the training program's objective of achieving individual resident competency with the parallel but overarching goals of aggregate, programmatic, and systemwide improvements in health care. The challenge for academic ophthalmology during this shift from the apprenticeship model to a competency-based model of education is the development and testing of tools to both teach and assess these new competencies. This is an exciting but daunting task that will require effort to move from tests of knowledge and recall alone (ie, “know how”) to oral reports (eg, presenting to an attending) of the data collection, interpretation, and synthesis (ie, “tell how”) as well as application in the real world (ie, “show how”). The end result of this multiyear process will hopefully allow professional educators, the public at large, third-party payers, and internal and external regulatory agencies to infer a physician's ability to “do” in the real world (ie, doing the right thing in the right way for the right reason and at the right time).1-3

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