Optimizing Graduate Medical Education

AAMC Road Map Seeks to Update, Strengthen U.S. GME System

March 16, 2015 01:43 pm Sheri Porter

The Association of American Medical Colleges recently announced a "comprehensive and sustained effort" to strengthen the U.S graduate medical education (GME) system.

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In a Feb. 24 news release,(www.aamc.org) AAMC President and CEO Darrell Kirch, M.D., introduced the AAMC plan -- molded into a document(www.aamc.org) titled Optimizing Graduate Medical Education: A Five-year Road Map for America's Medical Schools, Teaching Hospitals and Health Systems.

Kirch noted the country's rapidly evolving health care system and said the environment demanded new approaches.

"For decades, medical schools and teaching hospitals have been meeting these challenges with innovations in education, training and care delivery," said Kirch. This road map -- a comprehensive and sustained plan -- will further align medical education with current and future health care and societal needs to improve the health of all."

The plan lays out three broad strategic areas -- investing in future physicians; optimizing the environment for learning, care and discovery; and preparing the physician and physician scientist for the 21st century -- and focuses on seven priorities within those areas.

Story Highlights
  • The Association of American Medical Colleges recently released a five-year road map aimed at strengthening the U.S. graduate medical education system.
  • The plan lays out three broad strategic areas that it supports with seven priority actions.
  • Clif Knight, M.D., the AAFP's vice president for education, said the AAMC was moving in the right direction, and he stressed the AAFP's support for continued federal funding of teaching health centers.

In an interview with AAFP News, Academy Vice President for Education Clif Knight, M.D., said the AAMC had undertaken important work and was moving in the right direction.

"In its road map for optimizing GME, the AAMC has developed a set of priorities and goals that aim to increase accountability in GME and align the health care workforce with the kinds of physicians our patients need in their cities, towns and communities," said Knight.

"When the AAFP looks at community needs, the clear answer is family medicine," he said.

"The AAMC roadmap also is focused on ensuring public funding of GME, a priority that is consistent with the AAFP's vision and policy," said Knight, giving a nod to the AAFP's own groundbreaking report,(7 page PDF) "Aligning Resources, Increasing Accountability and Delivering a Primary Care Physician Workforce for America," released in September.

Among other things, the AAFP report stresses the need to continue funding teaching health centers -- funding that is now at risk of evaporating.

"We look forward to opportunities to synergize our efforts with the AAMC to achieve our shared ideals," Knight added.

Road Map Details

Addressing the strategic area of investing in future physicians, the AAMC noted that the country faces a physician shortage that is expected to accelerate as the population grows, diversifies and ages.

"Establishing a physician workforce able to meet the nation's future health care needs requires adequate investment in GME," said the AAMC in its report, but federal support for GME has largely been frozen since 1997, when Congress capped the number of residency positions funded by Medicare.

"As a result, the nation is rapidly approaching a point in which there will not be enough residency training positions for all the newly graduating physicians who must complete a residency before being able to enter practice," the AAMC said.

To help alleviate funding issues, the AAMC plans to

  • refine the metrics of accountability in GME by providing a clear accounting of physician training costs and what is covered -- and not covered -- by Medicare GME dollars,
  • align resident training positions with population needs and student desires, and
  • work to ensure public funding of GME by building a body of evidence that shows GME is a win for all.

The second strategic area -- optimizing the learning environment -- is built on the notion that physicians in training learn both in the classroom and in clinical environments.

According to the AAMC, "This area of focus requires consideration of the entire medical education continuum … and the environments in medical schools, teaching hospitals and health systems."

The dual goals in this area call on the AAMC to

  • define and foster optimal learning environments in AAMC member institutions and
  • improve the environment for teaching faculty at academic medical centers to allow them to thrive as they fulfill their institutional missions.

As for preparing physicians for the 21st century, the third area defined by the roadmap, authors note how much medial training and health care has changed since the early 1900s.

"Since 1911, the scope of practice and complexity of science and medicine has grown exponentially. Today, medical information is on pace to double every 73 days by 2020," wrote the report's authors.

They noted that care delivery, practice settings and payment structures were shifting to reflect the needs and wants of patients and payers. Today's patients want their physicians to "partner with them and to engage with the community to ensure they (the patients) stay well."

In addition, said the report, patients expect their physicians to act as advocates in helping to guide them through life's health transitions and end-of-life decisions.

"The imperative for physicians to be compassionate champions for health has never been stronger," said the AAMC.

In order to ensure that physician trainees are fully prepared to interact with and care for patients, the AAMC plans to

  • elevate the performance of physicians entering residency and of physicians new to practice, and
  • develop models and demonstrate ways to optimize the duration of education and training.

Eye on the Prize

This long-term push by the AAMC will be led by Kirch, AAMC Chief Medical Education Officer Maryellen Gusic, M.D., and AAMC Chief Health Care Officer Janis Orlowski, M.D.

Gusic told AAFP News that U.S. GME was at a critical juncture. "Recent emerging trends -- changing demographics, exponential growth in medical discovery, and new expectations about the way physicians and patients partner and interact -- demand new and innovative change in medical education and health care delivery," she said.

She predicted that the greatest challenge moving forward would be to "develop and sustain a process that continues to respond to emerging issues in a rapidly changing health care environment," …including a looming doctor shortage. Specifically, "How can we meet and align society's evolving health care needs with the way we educate and train physicians?" Gusic asked.

"Another challenge essential to the success of our efforts will be to actively engage a broad coalition of professionals, their societies and the public in these critical conversations," she added.

As to how the AAMC envisions the American GME system five years from now, Orlowski told AAFP News, "In five years, we hope to build on past successes to ensure a system of graduate medical education that is adequately funded, more accountable and better equipped to meet the health care workforce needs of the nation.

Through this plan, we are working toward a strengthened graduate medical education system that will ensure high-quality care for all Americans," said Orlowski.