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Aaron Kraut 1 Article
Use of graded responsibility and common entrustment considerations among United States emergency medicine residency programs  
Jason Lai, Benjamin Holden Schnapp, David Simon Tillman, Mary Westergaard, Jamie Hess, Aaron Kraut
J Educ Eval Health Prof. 2020;17:11.   Published online April 20, 2020
DOI: https://doi.org/10.3352/jeehp.2020.17.11
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AbstractAbstract PDFSupplementary Material
Purpose
The Accreditation Council for Graduate Medical Education (ACGME) requires all residency programs to provide increasing autonomy as residents progress through training, known as graded responsibility. However, there is little guidance on how to implement graded responsibility in practice and a paucity of literature on how it is currently implemented in emergency medicine (EM). We sought to determine how EM residency programs apply graded responsibility across a variety of activities and to identify which considerations are important in affording additional responsibilities to trainees.
Methods
We conducted a cross-sectional study of EM residency programs using a 23-question survey that was distributed by email to 162 ACGME-accredited EM program directors. Seven different domains of practice were queried.
Results
We received 91 responses (56.2% response rate) to the survey. Among all domains of practice except for managing critically ill medical patients, the use of graded responsibility exceeded 50% of surveyed programs. When graded responsibility was applied, post-graduate year (PGY) level was ranked an “extremely important” or “very important” consideration between 80.9% and 100.0% of the time.
Conclusion
The majority of EM residency programs are implementing graded responsibility within most domains of practice. When decisions are made surrounding graded responsibility, programs still rely heavily on the time-based model of PGY level to determine advancement.

Citations

Citations to this article as recorded by  
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JEEHP : Journal of Educational Evaluation for Health Professions