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AAMC Reporter: December 2005
A Word from the President:
"Forging a New Compact
Between Resident Physicians
and Their Teachers"
Last January in this column, I made a New Year's
resolution to see if we could end the debate about
whether residents in our teaching hospitals were primarily
employees who happen to learn something in
the course of doing a job, or whether they were primarily
students who perform some useful services as
an inherent part of their education. I think you know
what side I take in that debate.
To test how widely my view was shared—namely, that
residents are, indeed, students first and foremost—my
AAMC colleagues and I drafted a Compact Between
Resident Physicians and Their Teachers. Our goal was to
capture the underlying principles of graduate medical
education and to suggest the kinds of commitments
both faculty and residents had to make to one another
in order to sustain learning environments that foster
academic excellence, inspire the highest standards of
professionalism, and ensure the delivery of safe, high quality
care to patients.
We then circulated the draft widely for comment and
revision in the hope that a broad consensus might be
reached. I was enormously gratified with the response.
The vast majority of GME stakeholder organizations
expressed strong support for the sentiments expressed
in the draft document and many offered excellent suggestions
for ways to improve it.
A final version of the Compact was released at the AAMC
Annual Meeting last month and is being sent to GME
program directors and their sponsoring institutions
throughout the country. The intent is that the document
be viewed, not as an AAMC statement, but as an
expression by the broad GME community about what
graduate medical education is all about. Now that we
have finally grappled with the need to limit resident
duty hours, the time is ripe for us to refocus our efforts
to ensure that the "E" in GME regains center stage.
The task will not be easy. GME program directors and
their faculties confront colossal challenges. For openers,
they are obliged to take under their wing graduates from
very diverse educational backgrounds, to say nothing of
those from the four corners of the globe. They then
must find ways to convert this highly diverse substrate
into a uniformly competent group of newly minted
practitioners. Compounding this challenge, they must
achieve their educational objectives in the midst of
an increasingly complex, stressful, fast-paced clinical
environment where faculty are hard pressed to find
time for teaching and program directors are hard
pressed to find the resources needed to mount an effective
curriculum. Moreover, this environment, far from
being conducive to education, places a premium on efficiency
and productivity, and it devalues the time
required for reflection and understanding.
It is into this set of realities that the Compact is being
introduced. The core tenets of the document are:
- Excellence in Medical Education—Resident physicians
are first and foremost learners. Institutional sponsors
of residency programs and program faculty must be
committed to maintaining high standards of educational
quality. The patient care services provided by
residents in the course of fulfilling their duty assignments
should be determined primarily by their
educational needs.
- Highest Quality Patient Care and Safety—By allowing
resident physicians to participate in the care of their
patients, faculty accept an obligation to adhere to
uncompromised standards of quality medical care.
Moreover, preparing future physicians to meet
patients' expectations for optimal care requires that
they learn in clinical settings epitomizing the highest
standards of medical practice.
- Respect for Residents' Well-being—Fundamental to
the ethic of medicine is respect for every individual.
As the program faculty's most junior colleagues, resident
physicians are especially vulnerable, and their
well-being must be accorded the highest priority.
Acknowledging the uncommon stresses inherent in
fulfilling the demands of their training, residents
must be allowed sufficient opportunities to meet personal
and family obligations, to pursue recreational
activities, and to obtain adequate rest.
To animate these principles, the Compact suggests 10
commitments each for faculty and resident physicians,
which are intended as a model for institutional GME
sponsors, program directors, and residents to tailor, as
they wish, to local circumstances. Among the ways the
Compact might be used in its original or modified form
are the following:
- As a recruitment tool to be distributed to prospective
residency applicants, signifying the program's commitment
to its core educational mission.
- As part of the orientation of first-year residents.
- As a point of departure for discussions with residents,
faculty, and institutional leaders about relevant
issues addressed by the Compact.
- As part of the orientation of new faculty.
- As part of the programs' written curricula to be
reviewed yearly with all residents and faculty.
- As a topic for residents' retreats, noon conferences, or
grand rounds to highlight exemplary as well as unacceptable
behavior and appropriate expectations of
both residents and faculty.
- As a component of resident and/or faculty evaluations.
- As part of the ACGME-required internal review of
the program's compliance with institutional standards.
- As part of a "Professionalism Ceremony" in which
the Compact could be signed by faculty and residents
as a formal pledge to uphold its commitments.
However it is used, I hope the Compact will serve as a
reminder to resident physicians and their teachers that
education is GME's principal obligation and that their
conduct in fulfilling their educational objectives is the
medium through which the profession inculcates its
ethical values.
Jordan J. Cohen, M.D.
AAMC President
Editor's note: For more information, go to www.aamc.org/meded/residentcompact/
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