■在本评论中,作者探讨了平衡医学教育中的高性能标准与这些标准对利益相关者的可接受性之间的张力(例如,学习者和患者)。然后,作者提供了一个镜头,可以通过它来考虑这种紧张关系,以及关注患者结果和学习者需求的前进道路。在考察这一现象时,作者认为,高性能标准往往是必要的。社会责任是医学教育的关键,公众要求培训计划为医生提供高质量的护理做好准备。医学院和住院医师计划,因此,需要严格的标准,以确保毕业生准备照顾病人。同时,学习者的经验是重要的考虑。确保绩效标准为利益相关者所接受,以支持评估决策的有效性。在考虑绩效标准时,公平也应该是计划评估和有效性论证的核心。目前,整个连续体的学习者都为下一阶段的培训做好了不同的准备,并且经常面临资源可用性方面的不平等,以满足高通过标准,这可能会导致学习者流失。许多面临这些不平等的学生来自代表性不足或处境不利的背景,对于确保多样化的医疗劳动力以满足患者和社会的需求至关重要。当这些学生挣扎时,它导致了更多社会经济和种族多样化申请人的管道泄漏。作者认为,四个关键因素可以平衡高性能标准和利益相关者可接受性之间的紧张关系:可接受和可辩护的标准,进程是时间可变的,为每个学习者量身定制的必要支持结构,和公平设计的评估系统。
In this commentary, the authors explore the tension of balancing high performance standards in medical education with the acceptability of those standards to stakeholders (e.g., learners and patients). The authors then offer a lens through which this tension might be considered and ways forward that focus on both patient outcomes and learner needs.In examining this phenomenon, the authors argue that high performance standards are often necessary. Societal accountability is key to medical education, with the public demanding that training programs prepare physicians to provide high-quality care. Medical schools and residency programs, therefore, require rigorous standards to ensure graduates are ready to care for patients. At the same time, learners\' experience is important to consider. Making sure that performance standards are acceptable to stakeholders supports the validity of assessment decisions.Equity should also be central to program evaluation and validity arguments when considering performance standards. Currently, learners across the continuum are variably prepared for the next phase in training and often face inequities in resource availability to meet high passing standards, which may lead to learner attrition. Many students who face these inequities come from underrepresented or disadvantaged backgrounds and are essential to ensuring a diverse medical workforce to meet the needs of patients and society. When these students struggle, it contributes to the leaky pipeline of more socioeconomically and racially diverse applicants.The authors posit that 4 key factors can balance the tension between high performance standards and stakeholder acceptability: standards that are acceptable and defensible, progression that is time variable, requisite support structures that are uniquely tailored for each learner, and assessment systems that are equitably designed.