AAHC president offers plan to improve graduate medical education

In a Health Affairs blog post, Association of Academic Health Centers (AAHC) President Steven Wartman, MD, PhD, wrote about ways he believes graduate medical education (GME) and residency can be improved.

Wartman wrote his recommendations based on what he heard at several regional roundtables convened by AAHC to “move beyond the contentious issues of funding and allocation of residency slots to take a look at the deeper complexities inside GME programs.” While the organization offered its own report earlier in August, Wartman said he “would like to share here my perspective as a former residency program director on these issues.”

While he wanted to avoid funding fights, “inherent organizational conflicts” were among the lessons he learned from the roundtables. He wrote that conflict is common between medical schools and the teaching hospitals where residents train, even when the facilities are owned by the same institution.

In one of the “four essential market dynamics” he said needed to addressed, Wartman wrote those facilities should have a close working relationship, especially to “ensure there is a far better match between health workforce supply and demand.”

Demand was one of the issues he said he was commonly brought up at the roundtables was provision of care to rural or underserved populations.

“Many participants in other regions discussed substantial concerns about the rural areas of each region and/or the underserved populations in urban areas,” Wartman wrote. “The challenges are similar—not just providing a physician, but the right physician, in terms of language, culture, and background, to best meet health needs.”

The other steps of his plan dealt more with the residents themselves, as he said he was surprised to hear so many concerns about the stress put on young physicians.

His next recommendation was to redistribute the cost of education so student debt is less of a factor on where graduates choose to start their careers and what specialties they select. Some expense and time could be saved, he wrote, if pre-medical, medical school, and residency education were better integrated. Lastly, accreditation and licensing bodies should be pushing for real improvements in the industry, not just act as “guardians of the status quo.”

Along with dealing with those market dynamics, Wartman said physicians will need to be taught additional skills to handle the changing roles of their profession, such as:

• Management and oversight of delegated responsibilities within care teams.
• Monitoring and managing large amounts of patient data generated by wearables and large biobanks.
• Integrating artificial intelligence and big data into day-to-day clinical practice.
• Adapting their practice to performance measurement and value-based payment.
• Proactively promoting population health in addition to treating individual patients.

In his conclusion, he said the emphasis on recruiting more people to become physicians and work in healthcare would be “a redundant effort” without these kind of broader changes to medical education.