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BACKGROUND: Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of ones abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES: We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS: In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS: One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p  0.05). CONCLUSIONS: We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.

To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.

InVieth v. Jubilirer(2004) the Supreme Court found that claims of political gerrymandering could not be adjudicated by the courts. The reason for this was the finding that there did not exist a suitable standard to determine the existence of a political gerrymander that was both constitutionally justified and practically manageable. This paper questions the social science assumptions behind this finding. In particular it questions the assertion that the proposed standard that a majority of voters should be able to elect a majority of representative rests on a group right to equal representation, which does exist in the Constitution. Using social choice theory it is shown that the standard can be sustained strictly in terms of granting equal rights to individuals. The paper also considers how such a standard could be practically applied.

This article shows that for a single-vote electoral system for a representative body to treat all voters and all parties equally, it must produce results essentially identical to list proportional representation (PR). Democratic theory has often been agnostic concerning representative institutions. Different institutions have been compared in terms of behavioral outcomes rather than axiomatic properties. Building on van der Hout (Annual meeting of the Public Choice Society, San Diego, 2002) result, we show that for an electoral system to completely respect the principle of liberal political equality and popular sovereignty, its results must be equivalent to those of list PR.

Arend Lijphart’s conceptualization of the distinction between consensual and majoritarian democracy has been one of the most important developments in the study of comparative political systems in the last thirty years, and has indeed served as an antidote to the anglocentrism that previously existed in the study of democratic institutions. However, the concept of consensual democracy is problematic from the point of view of social choice theory. Theorists of consensual democracy have emphasized consensus as an alternative to majority rule. This paper argues, however, that many of the countries most often cited as “consensual” are actually amongst the world’s purest examples of government by majority rule, having virtually no constitutional checks and balances. Furthermore,the institutions of consensual democracy follow axiomatically from the requirement of political equality. Far from being a new form of democracy, consensual democracy might better be described as “simple democracy”.

The peer-reviewed papers gathered here are representative of the work presented at the first graduate student conference organized by the Center for the Study of Democracy, in February 2005. The conference focused on the development of democracy to better understand the fundamentals of the process. The conference drew submissions from Ph.D. candidates from seven schools in the Southern California area, covering a range of disciplines, methodologies, geographic concentrations and substantive questions about democratic development in the "established" democracies, consolidating democracies, or democratic transitions.

This paper tests the commonly held belief that the extremely proportional electoral system used in Israel gives disproportionate influence to small parties. This hypothesis is tested using power score analysis of the bargaining power of small parties in the Israeli Knesset (Penrose 1946, Banzhaf 1965), and also by considering the degree to which small parties have been able to win a disproportionate number of cabinet portfolios. Considering the period 1977-2003, we find that small parties only have disproportionate bargaining power in three Knessets in the 1980s, and in only one of these were they able to obtain more cabinet seats than their size would predict. Small parties only have disproportionate bargaining power in elections where the two large parties are essentially tied. Given that this situation will produce a hung parliament and give small parties the balance of power in most electoral systems (including single-member district plurality), we should be very careful about generalizing from the Israeli case to the performance of proportional electoral systems overall.

It has frequently been argued that proportional representation lead to national politics with little or no regional representation. We examine this in the case of the two most extreme cases of proportional representation, Israel and the Netherlands. We find that actually there are very distinct patterns of geographical representation. Although central metropolitan areas are somewhat over-represented in the legislatures, so are the most peripheral regions. This is due to the fact that parties tend to choose representatives from the geographical regions where they expect to be electorally competitive. Furthermore, proportional representation does not necessarily lead to nationally competitive parties, as in Israel. We also consider the relationship between geographical and other aspects of descriptive representation, such as gender and ethnicity.

This paper demonstrates that majority rule offers more protection to the worst-off minority than any other system, in that it maximizes the ability to overturn an unfavorable outcome. It is known (May 1952, Dahl 1956) that majority rule is the only decision rule that completely respects political equality. However, it is frequently argued that other decision rules (such as system of checks and balances, which are implicitly super-majoritarian) better serve the goals of protecting minorities rights and preserving stability. This paper argues that this trade-off is illusory and that majority rule actually provides most protection to minorities. Furthermore it does so precisely because of the instability inherent in majority rule, which overcomes the problem of majority tyranny.