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Graduate Medical Education: An Investment in Our Future

September 27, 2016

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Darrell G. Kirch, MD
Darrell G. Kirch, MD

On March 18, the AAMC joined medical students, faculty, and medical school administrators around the country in celebrating Match Day—the annual event at which medical students learn where they will complete their residency training. I know we all are delighted to see students who have worked so hard for four years in medical school take the next step toward achieving their dreams. This year, nearly 94 percent of U.S. MDs matched to residency positions, with close to 80 percent matching to one of their top three choices. This rate of success reflects not only the accomplishments of medical students, but also the hard work of the advisors and mentors who help students match to training positions that both fit their talents and help them reach their career goals.

Despite the happiness of Match Day, I could not help but reflect on the students who did not match to a residency position. With our nation facing a serious shortage of between 61,700 and 94,700 physicians by 2025, any number of medical students who do not have the opportunity to complete residency training—an essential step toward becoming a practicing physician—is a serious concern. Over the last several years, the AAMC and our medical schools have augmented resources and advising to help students match successfully. But we must also make sure there are an adequate number of residency positions to train enough doctors to meet the needs of America’s aging, growing population. Unfortunately, congressional caps on funding for residency training have been in place since 1997, impeding our ability to increase the overall supply of physicians. As we work with Congress to develop and pass legislation to expand funding for graduate medical education (GME), the AAMC and our member medical schools and teaching hospitals are also taking steps to strengthen residency training.

datashot_matchday2016chart.png National Resident Matching Program

One year ago, we launched the Optimizing GME initiative in an effort to foster innovation in both residency training and care delivery. In its first year, Optimizing GME has laid the foundation for major change across three areas of focus: investing in future physicians; optimizing the environment for learning, care, and delivery; and preparing the physician and physician-scientist for the 21st century. Our efforts to invest in future physicians encompass not only our advocacy work to increase federal support for GME, but also our efforts to align training in support of student desires and to refine the metrics of accountability for GME support.

Our Optimizing GME initiative also focuses on providing new physicians with the tools they need to meet the challenges of 21st-century practice. Today’s rapidly changing health care system requires that physicians possess not only medical knowledge, but less quantifiable skills such as communication, interprofessional collaboration, and capacity for practice-based learning. Working with our members, we are developing educational models to better understand and make decisions about the training and support learners need to develop these competencies at every stage of education, training, and practice. Over the last year, we have developed a constituent learning community around the Core Entrustable Professional Activities (EPAs) for Entering Residency, a common core set of behaviors and tasks that residents can be expected to exhibit or perform on day one of residency training. The goals of the learning community are to share knowledge, bring promising practices to scale, and adopt effective practices for teaching and assessing the Core EPAs. The community’s work will continue in the coming year, as we concentrate on improving the transition to residency and ensuring that entering residents are ready to meet the demands of 21st-century practice. We have also begun to engage stakeholders from licensing and accreditation bodies to study the implications of competency-based progression and the potential for shortened pathways to residency.

The stronger we make residency training, the better patient care will be now and in the future.

Additionally under Optimizing GME, we are studying effective strategies to cultivate and evaluate positive learning environments for students, residents, and faculty. We have seen alarmingly high rates of isolation, depression, burnout, and even suicide among physicians in recent years. Incredibly, more than half of physicians surveyed reported experiencing symptoms of burnout in 2014, according to a recent study published in Mayo Clinic Proceedings. Clearly, we must train students, residents, and practicing physicians at every stage of the continuum in strategies to strengthen their resilience. We must also begin to change the culture of medicine to foster resilience and better support of one another. This June, we will host a leadership forum at the AAMC to bring together the best minds across the academic medicine community to discuss strategies for combatting burnout and strengthening resilience.

Residency training is a vital step in a physician’s progression to practice. It offers new doctors supervised practice in an environment conducive to learning highly specialized skills, provides safe and effective patient care, and exposes residents to the latest advances in medical research. The steps we are taking through Optimizing GME to strengthen residency training will improve the work we do across all of academic medicine. The stronger we make residency training, the better patient care will be now and in the future. The more vital our research is, the better residents will understand how science influences their practice. And the more residents we train today, the more ready we will be to face the challenges of tomorrow.

This commentary originally appeared in print in the April 2016 issue of the AAMC Reporter.

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