Proposed changes to way medical residents are trained

Amy Farouk
Past Editor
AMA Wire
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An initiative to address the evolving needs of patients, trainees and the health care system could soon bring dramatic changes to residents’ clinical learning environments. Accreditation Council for Graduate Medical Education (ACGME) leadership spoke with AMA Wire® about how this initiative will support improvements in training and what it may mean for residents and the future of graduate medical education (GME).

The key areas for change

The ACGME last month announced its Pursuing Excellence in Clinical Learning Environments initiative, building on three years of the Clinical Learning Environment Review (CLER), an intensive examination of how successful the nation’s teaching hospitals and medical centers are at engaging residents in improving quality and safety in the systems of care in which they train.

“We recognized four overarching themes,” said Kevin Weiss, MD, senior vice president for institutional accreditation at the ACGME. The four themes cover a broad range of issues:

  • When it comes to training in patient safety and quality, residents need hands-on experience. “They have the knowledge but not the application,” Dr. Weiss said.
  • Educational goals for GME activities need to be in alignment with strategic planning around patient care. “The world of GME needs to be brought in much closer with alignment of patient service activity to drive the kinds of high-quality patient care we want to see,” he said.
  • Faculty need more advanced training in patient safety to train residents at the high level needed. Institutions need to invest in faculty development around patient safety, Dr. Weiss said.
  • Medical training needs to be integrated with other clinical professions. “We saw that medical education … often was happening a bit insular to the other clinical professions,” he said. Resources and the learning environments of the various professions need to be brought together to better train residents for the 21st-century health care environment.

A continuum of change

“We started to get a sense from the very beginning in our work on CLER that it may not be enough to simply inform the community about what we’re seeing,” Dr. Weiss said. “What we want to do is enhance the capacity of the community to define best practices and share them with each other.”

The Pursuing Excellence initiative aims to bring together teaching hospitals and academic medical centers in “a shared collaborative learning program, in which early participants develop innovations that are passed along to an ever-expanding circle of participants at other clinical learning environments,” Dr. Weiss and other ACGME leaders recently wrote in an article in the Journal of Graduate Medical Education.

If this collaboration concept sounds familiar, it should. It’s based in part on a model already proving effective in transforming undergraduate medical education. Since 2013, the AMA’s Accelerating Change in Medical Education Consortium has brought together leading medical schools to develop major innovations that are developing the components of the medical school of the future. Many of these innovations are being adopted at other medical schools as the consortium has expanded to include nearly one-fifth of the nation’s medical schools.

“We knew what we wanted to do; we just didn’t know the how and why,” Dr. Weiss said. “That’s when the AMA’s Accelerating Change in Medical Education initiative became a wonderful asset to help advance the thinking in our community.”

ACGME leaders came together with AMA leaders and heard insights from participants about the collaborative nature of the AMA consortium. “From that meeting, it became apparent that there’s such a compelling reason to develop the community’s capacity and develop a shared learning network. That enabled us to accelerate our idea forward,” Dr. Weiss said.

Susan Skochelak, MD, group vice president for medical education at the AMA, said she anticipates future collaborations among the schools in the AMA consortium and the eight sponsoring institutions that will be selected for the ACGME initiative.

“Our students and residents all train within the same learning environment and health care systems,” Dr. Skochelak said. “Natural collaborations already occur, and the AMA’s Accelerating Change in Medical Education initiative and ACGME are already working on ways to bring our two groups together to share innovations and best practices.”

“We know we can improve physician education,” she said of the two groups.“We aspire to so much more than settling for our current state of training. We want to develop the needed tools and best practices for our faculty, our residents and our students, to provide the best care to our patients and communities.”

What the Pursuing Excellence Initiative will mean for residents

Although changes rarely happen overnight, residents could soon start seeing changes that make a real difference in their training.

“Patient care will improve because the more we engage residents and give them tools, the more things will change,” he said. “Patient care will benefit. And leaders will evolve.”

Dr. Weiss said residents bring a lot to the table and already are making important changes when enabled to do so. “When you make a change, it can affect patients in the multiples,” he said. “One resident’s recent quality improvement project improved care for thousands—if not tens of thousands—of patients. That’s so rewarding for both the resident and patient care. Those are the kinds of changes that we are looking to accelerate.”

Next steps

The deadline for proposals from interested institutions is May 4, and the ACGME already has heard tremendous interest in the initiative. When the group issued a request for information in preparation for the initiative late last year, the majority of respondents indicated an interest in participating.

“We’re expecting a pretty robust set of applications,” Dr. Weiss said. “What’s most exciting is that we’re seeing it from a wide swath of interest, from the very large academic centers to the community hospitals and ambulatory care training sites, which are also asking if they can be a part of this. We’re looking for a balanced portfolio in those who are selected, so we have a balance of different types of institutions.”

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