AAFP Agrees With Most Changes to LCME's Accreditation Standard ED-15

Exception Is Other Groups' Call to Include Geriatrics as Specialty

January 19, 2010 10:50 am News Staff

The AAFP has submitted its generally favorable comments on changes the Liaison Committee on Medical Education, or LCME, has proposed for its accreditation standards. However, the Academy says it does not agree with other groups' call to list geriatric medicine among medical specialties named in one of those standards.

In a Dec. 21, 2009, letter from AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, to LCME Secretary Barbara Barzansky, M.D., M.H.P.E., Epperly praises the LCME for recognizing that the "standards for the basic and clinical science years need to change in response to the explosion in medical knowledge."

Epperly notes that the Academy is especially pleased that the proposed revision of standard ED-15 "specifically mentions the need to prepare students to care for individuals across the lifespan," a tenet of family medicine. He suggests, however, a slight rewording of the revision that would strengthen that concept.

Standard ED-15, which falls under the Educational Program for the M.D. Degree section of the LCME's "Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree"(www.lcme.org) document, deals specifically with curriculum content and clinical experiences.

The original (June 2008) standard ED-15 said, "The curriculum should include clinical experiences in family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery." The proposed revised (June 2010) standard says, "The curriculum of the educational program must prepare students to enter any field of graduate medical education and include content that will prepare students to recognize wellness, determinants of health, opportunities for health promotion, and symptoms and signs of disease; develop differential diagnoses and treatment plans; and assist patients in addressing health-related issues involving all organ systems and spanning the life cycle."

The Academy's suggested change is intended to place greater emphasis on the phrase pertaining to preparing students to provide care for patients at all life stages and to reinforce the LCME's intent "to ensure that the clinical content of medical education prepares them to care for individuals across the lifespan."

Similarly, the original annotation to standard ED-15 said, "Schools that do not require clinical experience in one or another of these disciplines must ensure that their students possess the knowledge and clinical abilities to enter any field of graduate medical education." The proposed revised annotation says, "It is expected that the curriculum will be guided by the contemporary content from and clinical experiences associated with, among others, the disciplines and related subspecialties that have traditionally been titled family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, public health and surgery."

Regarding the annotation for ED-15, Epperly notes that the AAFP agrees it is important for medical students to receive explicit training focused on the health care needs of older adults. However, the Academy does not support efforts by other organizations to recommend the insertion of "geriatric medicine" in the list of specialties.

"The inclusion of 'geriatric medicine,' a content area within family medicine, internal medicine and many other disciplines, is the first step on the 'slippery slope' of justifying the specific inclusion of all subspecialty areas," says Epperly.

"The groundwork has been laid for how medical schools should approach the task of (e)nsuring that graduating medical students are competent in care of older adults," the letter adds. "Under the auspices of the Association of American Medical Colleges, stakeholders have defined basic geriatrics competencies, which can be taught across the curriculum.

"In addition, over a third of U.S. medical schools have been working on infusing geriatrics into their training … and these schools serve as models for how this work can be accomplished within the constraints of a very tight curriculum."

The LCME will take final action on the proposed revisions at a Feb. 1-3 meeting.

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