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Graduated Responsibility

Finding the right tasks for each student

Trainees will have very different skills depending on their level of education. Your expectations, and the responsibilities you give them, should be adjusted accordingly.

Novice learners (Med 1 through early Med 3): At this stage, trainees are gaining skills in how to gather and organize a history. They are just learning what information they need to collect. They generally do not have the ability to filter or prioritize data; everything seems equally important. They may have some knowledge of anatomy and physiology but they are often not able to synthesize it into clinically relevant diagnoses. Because they have minimal experience of situations, they rely on rules and templates. Early learners may miss important verbal or non-verbal clues from patients. Novice learners should not be entrusted with significant patient care responsibilities. They often participate in patient care as observers or under direct observation.

Advanced beginners (Med 3 - early residents): At this stage, history taking and physical exam skills are more developed. This is the stage when clinical expertise evolves. It involves synthesis, sorting and prioritizing. The learners are less rule bound; they use their past experience to employ rules selectively. They filter data to focus on what is relevant. They may create personalized principles and guidelines. Advanced beginners may use pattern recognition to solve problems, see the big picture and how specific information relates to it. They begin to generate differential diagnoses that drive focused data gathering. They may be able to formulate a unified summary of a case with pertinent positives and negatives from the review of systems. These learners are typically eager to be involved in patient care but need close supervision. If not directly observed, their reporting of the patient presentation must be carefully reviewed for accuracy. Typically, these learners must report to their supervisor after each encounter and cannot manage patients independently.

Competent learners (senior residents): At this stage, residents will easily see the big picture in most cases. They can recognize common illness patterns. When encountering new or unfamiliar problems, they will often methodically reason through each step of a case. A competent learner will be assuming the responsibility of a caregiver; they will have emotional buy-in. They feel accountable for clinical decisions and are consciously aware of their own role in contributing to clinical outcomes. Trainees at this stage can see patients independently and will need only to have their work reviewed at the end of the day. 

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