The Quest Toward Unsupervised Practice

The ultimate goal of graduate medical education has often been described as supporting learners in the pursuit of independent practice. To achieve this goal, learners and supervisors attempt to balance autonomy vs supervision, defining autonomy as allowing a learner to make decisions in the absence of a supervisor, and supervision as ensuring that ultimate care decisions are in the control of a more experienced physician. These definitions are not only outmoded but perhaps were never correct. Instead, training must prepare learners for unsupervised practice, in which they interact with others (not act independently) and are afforded appropriate autonomy and levels of supervision during training. Indeed, this concept is now reflected in the educational competencies that have been developed by the Accreditation Council for Graduate Medical Education. It is not simply a matter of semantics. Overemphasis on independent practice as the goal beyond training threatens the openness of learners to seeking help when needed and misstates the goal they must strive to achieve. Without defining the intended goal— unsupervised practice—learners and supervisors risk losing focus on ensuring that learners make appropriate de