The following is a review of some of the important initiatives, events and publications that have occurred following the ABIM Foundation’s 2010 Forum, Transforming Medical Education and Training: Meeting the Needs of Patients and Society. Each of these activities aims to address one or more of the challenges involved in preparing the next generation of physicians for high performing, 21st century clinical practice.
TOP Meeting Faculty Needs For Teaching and Assessing 21st Century Practice Competencies
The three primary care certifying boards -- the American Board of Internal Medicine, the American Board of Family Medicine, and the American Board of Pediatrics -- along with the primary care specialty societies and academic leadership are working with the Health Resources and Services Administration (HRSA) to launch a national faculty development initiative. The initiative aims to provide the nation’s primary care faculty members with the skills, tools and ongoing support they need to successfully transition to a competency-based model of education and training (CBET), as mandated by the Accreditation Council for Graduate Medical Education (ACGME) and to prepare physicians-in-training for new models of care delivery.
This faculty-focused effort will help clinical educators gain comfort and proficiency in teaching and assessing 21st century practice competencies, including:
- Systems-based practice
- Practice-based (quality) improvement and learning
- Interpersonal and communication skills
- Using information technology (IT)
- Working in community-based settings
The initiative is key to accelerating innovation in primary care residency training and will build on lessons from Family Medicine’s P4 programs and new CBET pilots in Internal Medicine.
TOP Lessons from Exemplars in Ambulatory Training
In a follow-up to its 2009 Report to Congress, the Medicare Payment Advisory Commission (MedPAC) commissioned another site visit report by RAND Health that examines what factors foster and sustain innovation in ambulatory training. The report identifies specific financial, leadership, systems and ACGME/Residency Review Committees(RRC)-related factors for both educators and policymakers to consider.
TOP Development and Recognition for Master Clinician Educators
The Alliance for Academic Internal Medicine released a report calling for a new breed of clinical educator, the "Master Teacher," whose primary organizational role and commitment is educating young and future physicians.
The report proposes a skill set that master clinician educators will need to appropriately prepare physician trainees for the demands and expectations of 21st century practice, highlighting the breadth and depth of abilities these educators will need to fulfill their roles for their learners, patients and colleagues in health care. The report also identifies and makes recommendations to address issues related to training, financing, faculty role and documentation tools, and promotion and tenure.
TOP Foster Collaboration Across Accreditation, Certification, Testing and Licensure Organizations
A dozen organizations constituting the assessment, accreditation and credentialing bodies for both allopathic and osteopathic medicine have chartered a new entity to “provide a forum for dialogue among member organizations about ways to enhance physician accountability through continuous improvement in medical education, training and practice.” The coalition’s purpose is to enhance communication and coordination among the organizations that oversee the components of this continuum, particularly on issues that relate to self-regulation and public trust in the profession.
TOP Leveraging GME Funds to Drive Performance and Innovation
MedPAC Chair Glenn Hackbarth and colleague Christina Boccuti published a perspective in the New England Journal of Medicine on "Transforming Graduate Medical Education to Improve Health Care Value." In their article, the authors recommend that the government engage and catalyze the community of GME faculties, residency-accrediting and physician certifying organizations, insurers and patient representatives to develop performance-based standards and payment incentives that would better align GME training with the anticipated needs of a more effective and sustainable health care system.
TOP Enabling Training Redesign through Accreditation and Public Policies
The Josiah Macy Jr. Foundation and the Association of Academic Health Centers held the first of two planned conferences to develop recommendations regarding the future of GME in the United States.
The first conference, "Optimizing the Structure, Support, Oversight, and Accountability of GME to Best Meet the Needs of the American People," reviewed the current status of GME from a policy perspective, including the regulation, financing and “sizing” of GME. The proceedings suggest how the ACGME, through its accreditation requirements, can advance innovation in residency training and help determine the necessary contributions of both public and private payers. "Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System" is a summary of the conference.
At the second conference, "Reforming Graduate Medical Education to Meet the Needs of the Public," invited thought leaders examined the pedagogy, content, assessment, site and duration of graduate medical education. Conference proceedings will be published following the event and made available on our web site.
TOP Promote Inter-Professional Team-Based Care through Education, Evaluation, Assessment and Accreditation
HRSA, the Josiah Macy Jr. Foundation, the Robert Wood Johnson Foundation and the ABIM Foundation, together with the Association of American Medical Colleges (AAMC)and the Interprofessional Education Collaborative (a collaborative of six accrediting bodies for pre-licensure educational programs) are jointly sponsoring an initiative to engage a dynamic group of leaders from practice, academia, accreditation, regulation and health delivery systems to refine and promote the integration of a common competencies for interprofessional team-based care into health profession's education, training and practice.
The first phase of this work was presented in a National Press Club briefing on May 10, 2011. This is a priority line of work for HRSA; the Centers for Medicare and Medicaid Services (CMS) Innovations Center also has expressed interest in this effort.
The Agency for Healthcare Research and Quality (AHRQ) is working to define a set of measures for effective team-based care in the ambulatory setting that can be used to evaluate team-functioning and inform practice improvement efforts.
The Department of Veterans Affairs (VA) has created a new program of Centers of Excellence in Primary Care Education that will be an important test-bed for teaching team-based care concepts and evolving learning and performance metrics. Part of the VA’s New Models of Care initiative, the Centers will utilize VA primary care settings to develop and test innovative approaches to preparing physician residents and students, together with advanced practice nurses and nursing students and associated health professions trainees, to work in and lead patient-centered interprofessional teams providing coordinated longitudinal care. Five VA Medical Centers have been funded at roughly $1 million per year for five years (funding beyond fiscal year 2011 will depend on the VA's budget allocation).
TOP Valuing Behavioral and Social Sciences
Following an intensive three-year review, the AAMC has released preliminary recommendations for a new version of the Medical College Admission Test (MCAT).
The new recommendations include:
- Adding a new test of the behavioral and social sciences concepts that lay the foundation for medical students’ learning about the social issues of medicine.
- Revising the verbal section of the exam to test the way examinees reason through passages in ethics and philosophy, cross-cultural studies, population health and other subjects that emphasize a humanist orientation.
Through its Social and Behavior Sciences Medical School Objectives Project (MSOP) Committee, the AAMC also is developing learning objectives, educational strategies and resources for integrating the behavioral and social sciences into medical school curricula. A report is expected in summer 2011.