November 2, 2021, 4:04p.m. David Mitchell — The AAFP already is taking steps that address many of the recommendations outlined in a recent report that called for a comprehensive overhaul of the process that transitions medical students to residency training.
In 2020, the Coalition for Physician Accountability tasked a new committee with examining the transition from undergraduate medical education to graduate medical education and recommending solutions to numerous challenges associated with that transition. The coalition’s Undergraduate Medical Education to Graduate Medical Education Review Committee, which included multiple AAFP members, spent nearly a year studying the issues and formulating a response. The Academy provided input during multiple comment periods, and the AAFP’s feedback was reflected in the 275-page final report, and its nearly three dozen recommendations, that was issued in late August.
One recommendation called for specialty organizations “to perform workforce evaluations and specifically address diversity, equity, and inclusion associated with specialty-specific disparities in recruitment,” and another called for those in medical education to receive continuing professional development regarding anti-racism, avoiding bias and ensuring equity.
“This fits with our overall mission,” said AAFP Vice President of Medical Education Karen Mitchell, M.D., noting that growing a diverse workforce is one of the AAFP’s strategic priorities. The Academy’s EveryONE Project offers tools for increasing workforce diversity as well as implicit bias training resources.
Although the UGRC’s recommendations are specific to the pathway that connects medical school and residency, the AAFP reflected in its comments the importance of interventions in education before and when entering medical school. This year, the AAFP launched a new national program with HOSA Future Health Professionals, a U.S. Department of Education-recognized Career and Technical Student Organization that promotes career opportunities in health care to middle school, high school and college students. Participants will learn about family medicine with resources provided by the AAFP. Students also will have the opportunity to interview AAFP active and medical student members about their career paths. The students will then give a presentation to their peers about family medicine, and their presentations will be judged for potential awards at the local, state, regional and national levels. Twelve constituent chapters are working with the AAFP to pilot the program in their states this year.
“Some of these recommendations are a call to action for specialty organizations to step up and look at their practices related to increasing diversity in the workforce,” said Christina Kelly, M.D., Chair of the AAFP’s Subcommittee on Resident and Student Issues, which drafted the Academy’s formal comments to the UGRC. “That’s something the AAFP is already working on.”
Kelly said the Academy, which has roughly 33,500 student members and 14,300 resident members, sought member input, particularly from students and residents, to inform its comments.
“We have more student and resident members than any other medical specialty organization, and we felt it was our duty to advocate for them in the best way possible,” said Kelly, an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.
The UGRC called for all interviewing to be virtual during the 2021-22 Match season, and the committee called for research on the impact of virtual interviewing “to ensure equity and fairness.” In July, the AAFP and other family medicine organizations called for another virtual interview process.
COVID-19 forced the interview process online during the 2020-21 Match season, and more study is needed to evaluate the process, Mitchell said. The AAFP recently surveyed medical student members regarding their experiences during the 2020-21 cycle.
“Although it’s thought that virtual interviews might create more equity for candidates, we don’t really know that for certain,” Mitchell said. “Doing it for one more year allows us to experience and study it. What is its impact on the process? Does it create equity?”
Family Medicine, the journal of the Society of Teachers of Family Medicine, recently called for manuscript submissions for a themed issue that will explore the strengths, weaknesses and best practices of the virtual format. Deadline for submissions is April 1, 2022.
Another UGRC recommendation called for innovations to “reduce application numbers and concentrate applicants at programs where mutual interest is high.” There needs to be more effort, the UGRC said, to match the goals of applicants with the missions of programs.
Mitchell said the Academy is in the process of redesigning its residency directory. The upgraded tool, which likely will be launched in 2022, will give programs additional fields to provide more information to distinguish themselves in a crowded field.
“We want to assist candidates with finding programs that fit,” she said.
The UGRC indicated the need for “clear and accurate information regarding clinical and nonclinical career choices.”
UGRC member Michelle Roett, M.D., M.P.H., professor and chair in the Department of Family Medicine at Georgetown University Medical Center and MedStar Georgetown University Hospital, said that recommendation is critical for family medicine.
“How a student is directed to choose family medicine should be based on their experiences, whether they be clinical experiences or mentoring experiences,” said Roett, co-author of a best practice guide for increasing student choice in family medicine. “Most often students who choose family medicine say they did so because they have meaningful longitudinal mentorship. Students who don’t have access to that often choose family medicine because somebody erroneously gave them advice based upon test scores alone. We want to ensure that the clinical advising pool is well trained in professional identity formation and is well aware of the values of family medicine. The new ‘pass/fail’ environment for Step 1 and many medical school preclinical courses means we will need to rethink both our advising and assessment methods to help students on their career paths.”
Three other recommendations were related to advising resources for faculty and students. The Academy already offers open-access and comprehensive resources for students — walking them through each stage of the Match process — as well as tools for programs on workforce development and more. The AAFP also collaborated with STFM to create faculty resources to support students matching, including two special events for medical student advisors to help them provide guidance to students pursuing family medicine residencies.
The UGRC had representatives of national medical organizations, medical schools and residency programs, including family physicians John Gimpel, D.O., president and CEO of the National Board of Osteopathic Medical Examiners; Roett; Dan Sepdham, M.D., associate professor in the Department of Family and Community Medicine at the University of Texas Southwestern Medical Center, vice chair for academic affairs and associate residency program director; and Col. Pamela Williams, M.D., associate dean for student affairs at the Uniformed Serviced University School of Medicine.
The UGRC’s recommendations covered issues related to assessing intern readiness and providing robust orientation programs. Family medicine programs, Roett said, “already do a really good job from the residency readiness perspective.”
“I do feel like family medicine is a best practice in that space,” she said, “and so we were very vocal in informing those recommendations. However, there is still wide variation in what is accessible post-match during medical school compared to the residency orientation activities we excel in. We also need to be mindful of the needs of the international medical graduate constituency.”
Roett, who led the committee’s workgroup on diversity, equity and inclusion, said it’s unclear how long it will take the recommendations to be implemented because several of them included discussion of the need for piloting and evaluation plans. However, she does expect the recommendations to have broad support because the process included both residency and medical school accreditation organizations, as well as multiple other stakeholders, including students, residents and faculty.
Mitchell said there likely will be numerous opportunities for family physicians to participate in workgroups that examine issues related to the recommendations, such as creating standards for the interview, offer and acceptance process; revising the Medical Student Performance Evaluation; and defining specialty-specific competencies needed for a successful transition.
“I look forward to robust discussions in our family medicine educational community about where we can take action to improve the UME-GME transition,” she said.
Students can see their full spectrum of career opportunities in family medicine during a series of virtual events featuring family physicians from across the country who will share stories about their specialty choice and their daily lives.
Real Talk with Family Docs, a series of five interactive events between Nov. 9 and Dec. 14, will allow students to join small group conversations with multiple family physicians and learn where the specialty can take them based on their personal and career interests. Family physicians will answer students’ questions in events organized by the panelists’ geographic region:
Students can attend as many events as they like, but registration is required. Take advantage of these opportunities to hear from family physicians about why they chose family medicine and how they practice in this diverse specialty.