Residents: How would you transform GME?

AMA Wire
Email this page

Now that the consortium of schools in the AMA Accelerating Change in Medical Education initiative are making transformative improvements to undergraduate medical education (UME), it’s time to move onto graduate medical education (GME)—and input from residents is crucial to the process.

“What’s happening in UME is spreading to GME, and vice versa, so the line between the two is really blurring,” Susan Skochelak, MD, AMA group vice president of medical education (pictured left), said at a special session for residents and fellows during the 2014 AMA Interim Meeting. “You’re leaders already, you’re leaders in the system you’re working in. And all the things you see, all the things that you wish for—you can contribute that to the national dialogue.”

Dr. Skochelak gave residents an update on the AMA’s progress in medical education transformation, discussing how the consortium has spent the last year developing and implementing new ideas to change the way future physicians are trained. The schools are working on things like competency-based assessment, incorporating systems-based practice and team-based care teachings into curriculum, and focusing on diversity and health care disparities. Using new techniques and technologies, the schools hope to create adaptive, lifelong learners.

None of these changes will happen in a vacuum, Dr. Skochelak said. Any change at the undergraduate level will affect residency programs as well.

For example, if UME can be competency-based, and students can progress at their own rate through school and potentially graduate early, what happens with timing of the Match? Would med school graduates need to wait until July to start residency, or could they start at different points in the year?

“The answer’s not there right now, but we do have to start asking the questions,” Dr. Skochelak said.

Residents at the session shared what they believe to be challenges, including:

  • More education in business and economics at the UME level
  • New ideas for decreasing the amount of paperwork residents must complete during their work or training for how to do this more efficiently
  • How to standardize assessment, given that UME programs could change dramatically

The AMA’s consortium will spend the next year developing ways to involve GME in its work.

Further, AMA policy calls on the association to work with key external stakeholders, including the Accreditation Council for Graduate Medical Education and National Resident Matching Program, to investigate the continuum of medical education through development of pilot projects. Read more in the AMA Council on Medical Education’s report (log in).

Share your ideas to transform residency training: Post your comments below at AMA Wire® or on the AMA Resident and Fellow Section Facebook page.

Email this page


The AMA adopted the following policy in 2013 to promote pilot study of one route to GME expansion in clinic settings. It was brought by the IMG Section and gained support from the CME, MSS, RFS, Population Health, and other sections. It can be funded largely through sources already available to retain providers of mid-level care. The policy reads:<br/> <br/> "D-310.953 Exploring the Feasibility of Clinic Based Residency Programs.<br/> Our AMA: (1) advocates that key stakeholders, such as the Accreditation Council for Graduate Medical Education, explore the feasibility of extending residency programs through a pilot study placing medical graduates in integrated physician-led practices in order to expand training positions and increase the number of physicians providing healthcare access; and (2) encourages that pilot studies of clinic-based residency program expansion be funded by private sources. (Res. 906, I-13)"<br/> <br/> This policy has yet to be widely promoted or attempted as a pilot.<br/> <br/> As the resolution's author I got great support from our Section, the CME, and other editors. I would love to see all good innovations get such support. But for society to benefit from innovations those ideas have to be put into practice. With our shortage of physicians and growing patient needs, available unmatched doctors seeking residency, and burgeoning medical student body, shouldn't we initiate the GME expansion model called for in our policy now? What can medical students, graduates, residents, and other stakeholders seeking adequate GME infrastructure do to help institute this and future AMA innovations?<br/> <br/> Any interested in reading the half page framework statement for the above resolution should find it in the comment section below later today. Thank you. DLD
Below is the framework statement referred to in my earlier comment. Many have read and provided invaluable commentary on this proposal who will be credited more fully elsewhere.<br/> <br/> If you have any comments or suggestions please post them below. Also, keep innovating! I'm grateful to be able to share our work but it would be really excellent if we could generate 5-10 or more proposals and begin to transform and increase GME.<br/> <br/> D-310.953 Framework:<br/> <br/> In 2013 the AMA adopted the policy D-310.953 to explore an outpatient residency training model. Through this model, medical graduates would be employed to increase patient access to physicians by providing graded supervised medical management in Integrated Physician Practices (IPPs), Accountable Care Organizations (ACOs), and other outpatient and critical access centers affiliated with residency programs. This would increase the quality of team based care to outpatient and underserved patients. Trainees at teaching hospital affiliated IPPs/ACOs would augment the number of physician providers in the U.S. To ensure full didactic and clinical experience, IT based support and exchange rotations would complement outpatient experience with academic training and inpatient services. Training at outpatient sites would develop integrated team management skills in all trainees and would promote a greater culture of expertise within those care delivery systems.<br/> <br/> Lower outlay is required to hire physicians in training who can supply more expert mid-level care. Costs for academic support can be met through private and public sources. Incentivized practice models would instill trainee economy, efficiency, productivity, and accountability; savings realized by trainees would improve practice margins. Teaching hospitals would in turn profit by affiliating with PCMHs and by providing rotating house staff experience in team based medical home environments and outpatient management. In this model, residents with prelim year completion who qualified and wished to go into primary care could further pursue their training and apply for board certification. They would simultaneously provide outpatient sites with a layer of senior residents offering increased autonomy for management. After completing typical licensing milestones IPP/ACO based residents would qualify for full licensure through the standard channels.<br/> <br/> This model would transform GME by increasing opportunities for all participating trainees to gain outpatient management experience. It would fund outpatient positions with available resources. Ultimately it would increase the number of GME slots in the U.S. helping provide an appropriately sized and outpatient savvy physician workforce.<br/> <br/> - Liske-Doorandish, D; Lal, R; Rasmussen, H; Kaur, H; Menon, N; et al
Show Comments (2)
Oct 19, 2016
How an approach, dubbed hotspotting, aims to build a system of multidisciplinary, coordinated care that can meet patient needs by addressing nonmedical issues that affect health.