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A Word From the President: Putting the Spotlight on GME—Now and Into the Future

AAMC Reporter: June 2014

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

I cannot recall a time when graduate medical education (GME) was more in the spotlight than today. If Congress does not lift its longstanding cap on the number of federally supported residency training positions, our nation will slip further into a physician shortage that will affect every American’s access to health care, starting with the most vulnerable. We are entering a whole new health care landscape fueled by the Affordable Care Act. Medical education, patient care, and medical research must evolve to keep up with shifting U.S. demographies, new technologies, changing health care delivery systems, and demands for increased accountability, quality, and safety. Collectively, the new physicians we are educating and training today will treat millions more patients than the U.S. health care system has ever accommodated. The burden will fall on them to reduce the serious health disparities in this country, too.

Recognizing that GME is at a critical juncture, the AAMC Board of Directors, under the leadership of our chair, Lorris Betz, M.D., Ph.D., has made GME a focus across the association, its councils, organizations, and affinity groups for at least the next year to 18 months. Robert Englander, M.D., AAMC senior director of competency-based learning and assessment, is working directly with me as I lead this effort. We started by identifying three core GME areas in which the AAMC already is very active: ensuring investment in the next generation of physicians, optimizing the learning environment, and preparing the physician and physician-scientist workforce for the 21st century. We believe these core areas represent the issues of greatest importance to our members and society at large.

Sustainable Funding. With a growing and aging population that will need more health care services than ever before, the AAMC is focused on obtaining sustainable federal funding for GME that will support the needs of Americans and continue to advance innovation. To ensure there are enough residency training positions for U.S. medical school graduates (this year, 412 were left with no PGY1 position), the AAMC is working with members of Congress to pass legislation that would train 4,000 more physicians a year in primary care and other shortage specialties over the next five years. Passing this legislation would reduce the projected physician shortage by a third and allow time for testing new models of payment and team-based interprofessional care. The recent problems surfacing at VA hospitals, which in part relate directly to physician shortages, are only the beginning if we do not find a way to increase the number of federally supported residency training positions.

Optimizing the Learning Environment. We must ensure that faculty members and our clinical systems have the best resources to teach students and trainees about quality improvement, patient safety, and health disparities. Research shows that training at a site with high-quality outcomes is a powerful influence on how well a physician performs for 15 years following residency. One example of how we are addressing this need is the AAMC Teaching for Quality (Te4Q) program, which trains clinical faculty at medical schools and teaching hospitals about methods to teach students and residents quality improvement and patient safety. Our workshops and publications on teaching cultural competence also are helping faculty and our member institutions reduce health disparities. In addition, the AAMC and its members are working together to ensure a positive and respectful learning environment and address concerns about mistreatment.

Preparing Physicians for the 21st Century. With medical education moving toward assessment of educational outcomes rather than only educational processes, the AAMC is striving to establish a true continuum of medical education through competencybased learning. Our recent publication, Core Entrustable Professional Activities for Entering Residency, is the first formal outline of the activities and requisite competencies and behaviors that every graduating medical student should be able to perform without supervision upon entering residency. Training future physicians to work in teams is another area of focus we are building through the Interprofessional Education Collaborative (IPEC), which includes our colleagues in nursing, dentistry, osteopathic medicine, pharmacy, and public health education. With our chief medical education officer, Carol Aschenbrener, M.D., taking the lead for the AAMC, IPEC is creating a national clearinghouse of competency-linked learning resources for faculty on interprofessional education and models of team-based or collaborative care.

Next month, the Institute of Medicine (IOM) is expected to release a report that is bound to galvanize the debate over the future of GME. While we do not know what changes the IOM will propose, we are concerned that the most well-intentioned recommendations could dramatically destabilize the effectiveness of the current system. While there is certainly opportunity for change and improvement, the current physician training system works relatively well—training 26,000 new doctors every year. Training physicians in teaching hospitals and affiliated sites gives them essential exposure to a wide range of patients and conditions. Shifting federal support for GME away from teaching hospitals will not serve the nation’s long-term health care needs well. In fact, nearly all primary care core specialties (and 93 percent of all core residency programs) already train residents in a variety of community and outpatient sites besides teaching hospitals.

Our GME system is under great stress now. Through our collective experiences and wisdom, however, we can help the best physician training model in the world reach its full potential and raise the level of health care that every American receives. The AAMC will continue to work on all fronts to improve GME. We will keep engaging the AAMC membership on current initiatives through our councils, organizations, and affinity groups, and also in conversation and blue-sky thinking on this issue. I encourage you to share your vision with us about GME and how the AAMC can help us get there.

“Our GME system is under great stress now. Through our collective experiences and wisdom, however, we can help the best physician training model in the world reach its full potential and raise the level of health care that every American receives.”

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