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A Word From the President: The Class of 2014: New Doctors for a New Health Care System

AAMC Reporter: May 2014

Darrell G. Kirch, M.D., AAMC President and CEO

It was a great honor to deliver four medical school commencement addresses this month. Seeing the enthusiasm and promise of tomorrow’s physicians, scientists, and medical educators is always a thrill.

This year’s graduating class of physicians will enter a health care system unlike any other before it. Implementation of the Affordable Care Act is slowly but surely reshaping the health care landscape. Our growing and aging population, compounded by the physician baby boomers who are themselves nearing retirement, is triggering a serious physician shortage. The need for more physicians, and indeed health care professionals of all kinds, has never been greater.

The influx of millions of newly insured Americans to the health care system means we must continue to adapt and innovate in the way we educate and train tomorrow’s doctors. While we have made great strides in improving medical education, we can do more. It is time to reframe our thinking and anticipate the changes that will come with the Affordable Care Act and a more diverse patient population.

The bar has been raised since I was in medical school. We look to this next generation of physicians to have superior communication skills and the ability to manage multiple chronic conditions, cultural sensitivities, conditions of aging, mental health problems, compliance issues, and other circumstances reflecting a new age in health care. It is up to us to train doctors to work effectively in this increasingly complex health care landscape.

To do this, we cannot depend on the curricula and teaching methods that worked well for us for so many years. Moreover, in order to provide compassionate, competent, and safe care, it will be critical for physicians to be adept at managing multiple sources of information—from the patient, diagnostic tests, other health professionals, and the medical record—and putting it in sociocultural context to make vital decisions. The use of technology has exploded and revolutionized how we teach as well. And perhaps most important, as the very nature of health care delivery is evolving, medical schools are training students to work collaboratively and effectively in high-functioning interdisciplinary teams across health professions. The AAMC’s work with the Interprofessional Education Collaborative is spearheading this transformation.

Another major change in medical education is the movement toward competency-based education. The AAMC is building on this momentum with our new release of the Core Entrustable Professional Activities (EPAs) for Entering Residency. This resource is a call to action to think differently about the competencies that all medical school graduates need before beginning residency training. The 13 activities in the Core EPAs are the first standardized set of guidelines defining what activities a medical school graduate should be able to perform without direct supervision on the first day of residency, regardless of his or her specialty. There is still more work to be done, including a pilot for individual schools to beta-test the EPAs and share their lessons learned. When completed, documenting students’ ability to perform the Core EPAs prior to residency will ensure not only their own professional progress, but also better care for patients.

Educating and training physicians for the future starts with the process of identifying and selecting them. The new MCAT® exam that will be launched in April 2015 will shift the exam’s focus from measuring what test-takers know, to testing how well they use what they know to solve problems. A new section will address behavioral and sociocultural issues that play critical roles in health and illness. Scores will be reported on a different scale to draw attention to exceptional applicants in the center of the score range, too—not just the top third—who might get overlooked otherwise. These modifications to the test are intended to help admissions officers select precisely the type of student who will be successful and able to make meaningful contributions in the new health care environment.

More medical schools are increasing diversity in the classroom by implementing holistic review during the admission process. Studies suggest that diversifying the physician workforce is the most effective way to reduce health care disparities and increase the number of physicians who will choose to work in underserved areas where we need them. For our part, the AAMC will continue to actively engage with and support medical schools as they integrate holistic review into their admission programs. This effort includes sponsorship of faculty development workshops on teaching respect and culturally sensitive communications to students as well.

With so many innovations underway in medical education, it surprises me when I still hear some people remark that medical education has not changed since the Flexner Report in 1910. When you visit as many medical schools across the country as I do each year, you see the vitality of our administrators and faculty in keeping curricula fresh and program opportunities timely. I have been pleased to witness a surge in initiatives to promote student and resident interest in global health, rural health, and service to disadvantaged communities.

Finally, in addition to all the dimensions outlined above, we are teaching students about responsible stewardship, too. Forward-thinking medical schools are developing strategies to teach students about cost containment and outcome measures so they can use medical resources more efficiently— a priority today in the fabric of health care decision-making.

We are entering a new era in medicine and it is up to us to produce students who can continue to forge progress in our health system. After talking to members of this year’s graduating class at commencements across the country, I feel confident that we are heading in the right direction. If you need any proof that medical education has come a long way since the Flexner Report, I am very proud to introduce you to the Class of 2014.