Each summer, teaching hospitals undergo a transformation as a team of experienced residents leave and are replaced by trainees fresh out of medical school. Some view this as a time of peril for patients—commonly referred to as “the July effect.” This year brings the possibility that the danger could be amplified as the agency overseeing residency programs rolls out a new evaluation system July 1.
In the United Kingdom, the resident turnover is referred to as the “August killing season.” But experts are predicting that the Accreditation Council for Graduate Medical Education's Next Accreditation System, or NAS, could lead to a safer healthcare system because of its focus on measuring outcomes rather than evaluating processes.
Specifically, the ACGME will require institutions to evaluate residents at different points or milestones in their training for competency in patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. In July, NAS will be rolled out for residency programs in seven specialties. It will be rolled out for the 19 other specialty programs ACGME oversees in July 2014.
Program administrators are not anticipating a more hazard-filled July because of NAS, just a heavier workload. But it is work that they say will help raise the level of safety and quality of the care.
“Staff will be required to be more hands on than ever before,” said Dr. Chad Vokoun, associate program director for internal medicine at the University of Nebraska Medical Center College of Medicine in Omaha.
Dr. Susan Vanderberg-Dent, associate dean of the graduate medical program at Rush University Medical Center in Chicago, agreed. “From an institutional perspective, it's going to be a lot of work,” she said. “But, ultimately, it will have a salutary effect.”
In fact, Vanderberg-Dent's colleague, Dr. David Ansell, called the accreditation changes “one of the greatest things to happen in medical training.” Demonstrating residents' competency in practice-based learning and improvement requires integrating residents' training into an institution's efforts to improve quality and patient safety, said Ansell, chief medical officer at the medical center and associate dean for clinical affairs at Rush Medical College.