Colbert Colleen Y, French Judith C, Herring Mary Elizabeth, Dannefer Elaine F
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Department of Medicine, Cleveland Clinic, Cleveland, OH, USA.
Perspect Med Educ. 2017 Oct;6(5):347-355. doi: 10.1007/s40037-017-0359-8.
Competency-based medical education systems allow institutions to individualize teaching practices to meet the needs of diverse learners. Yet, the focus on continuous improvement and individualization of curricula does not exempt programs from treating learners in a fair manner. When learners fail to meet key competencies and are placed on probation or dismissed from training programs, issues of fairness may form the basis of their legal claims. In a literature search, we found no in-depth examination of fairness. In this paper, we utilize a systems lens to examine fairness within postgraduate medical education contexts, focusing on educational opportunities, assessment practices, decision-making processes, fairness from a legal standpoint, and fairness in the context of the learning environment. While we provide examples of fairness issues within US training programs, concerns regarding fairness are relevant in any medical education system which utilizes a competency-based education framework.Assessment oversight committees and annual programmatic evaluations, while recommended, will not guarantee fairness within postgraduate medical education programs, but they can provide a window into 'hidden' threats to fairness, as everything from training experiences to assessment practices may be examined by these committees. One of the first steps programs can take is to recognize that threats to fairness may exist in any educational program, including their own, and begin conversations about how to address these issues.
基于能力的医学教育系统允许院校将教学实践个性化，以满足不同学习者的需求。然而，对课程持续改进和个性化的关注并不能使项目免于以公平的方式对待学习者。当学习者未能达到关键能力要求而被置于试用期或被培训项目开除时，公平问题可能构成他们法律诉求的基础。在文献检索中，我们未发现对公平性的深入研究。在本文中，我们运用系统视角来审视研究生医学教育背景下的公平性，重点关注教育机会、评估实践、决策过程、法律层面的公平以及学习环境中的公平。虽然我们提供了美国培训项目中公平问题的示例，但在任何采用基于能力的教育框架的医学教育系统中，对公平性的关注都是相关的。评估监督委员会和年度项目评估虽被推荐，但并不能保证研究生医学教育项目中的公平性，但它们可以为公平性的“隐藏”威胁提供一个窗口，因为从培训经历到评估实践等一切都可能由这些委员会进行审查。项目可以采取的首要步骤之一是认识到公平性威胁可能存在于任何教育项目中，包括其自身项目，并开始讨论如何解决这些问题。
