The nation's physician-training programs are set to undergo a restructuring, phased in over two years starting in July 2013, which will ultimately result in a system where accreditation is based on educational outcomes.
Doc-training programs to be judged on outcomes
In a special report co-written by Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education and posted on the New England Journal of Medicine website, it's stated that the effort, known as the Next Accreditation System, will also “enhance the ability of the peer-review system to prepare physicians for practice” and reduce administrative burdens “associated with the current structure and process-based approach.”
“Program requirements have become prescriptive, and opportunities for innovation have progressively disappeared,” Nasca and his co-authors wrote. “As administrative burdens have grown, program directors have been forced to manage programs rather than mentor residents, with a recent study reporting administrative tasks related to compliance as a factor in burnout among directors of anesthesiology programs.”
Starting in July 2013, seven of the ACGME's core specialties (emergency medicine, internal medicine, neurologic surgery, orthopedic surgery, pediatrics, diagnostic radiology and urology) will begin implementing the new system with the rest doing so in July 2014. According to the report, programs that demonstrate high-quality outcomes—based on data collection and trend analysis—will “be freed to innovate by relaxing detailed process standards that specify elements of residents' formal learning experiences.”
Nasca and his co-authors explain that “a key element” of the new system will be reporting on medical residents' educational milestones; to meet those milestones, medical students must demonstrate competency in patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication.
It's also mentioned in the report that ACGME site visits will be made to assess the learning environment and to generate data that can be used on national efforts to identify “program and institutional attributes” on resident learning and the quality of care they deliver after finishing the program.
The new program has not been fully tested, but it's stated in the report that “pivotal elements” have been tested successfully in internal and emergency medicine.
“By encouraging high-performing programs to innovate, the system will open the quality ceiling and produce new learning,” Nasca and his co-authors concluded. “Simultaneously, an ongoing process-based approach for programs with less-than-optimal performance will continue to raise the floor for all programs.”
The ACGME announcement comes after the Association of American Medical Colleges last week announced changes to the Medical College Admission Test, which include adding sections on "psychological, social and biological foundations of behavior," and "critical analysis and reasoning skills."
Those changes are expected to be implemented by 2015, with the revised test expected to be in use until 2030.
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