Macy Foundation Calls for Reforms to U.S. Graduate Medical Education

The Josiah Macy Jr. Foundation has released a report calling for sweeping reforms of the content and format of U.S. graduate medical education (GME) to ensure that physicians are trained more effectively and efficiently to meet public needs. Such factors as changing demographics, growth in health care technology, the monumental costs of our current health care system, and many others prompted the foundation to sponsor two conferences over the past year. The most recent, held in May 2011, generated the recently released report, “Conference Summary: Ensuring an Effective Physician Workforce for the United States: Recommendations for Reforming Graduate Medical Education to Meet the Needs of the Public.” The report outlines six recommendations for medical educators, leaders of institutions that train residents, and groups that set graduate medical education standards, such as the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties.

According to the report, “The public expects the GME system to produce a physician workforce of sufficient size, specialty mix, and skill to meet society’s needs. Many observers from both the public and professional vantage points feel it is currently falling short in each of these dimensions.” As a result, the report urges graduate medical education to become more accountable to the public, including maintaining an ongoing exchange. Other public health-oriented recommendations include expanding training content and sites to reflect current and future patient needs.

One recommendation encourages curriculum changes that would have a direct impact on osteopathic medical colleges. The report encourages collaborative education, with revisions to current regulations that prevent supervision across specialties or professions. Earlier this year, the Macy Foundation was also part of a release of core competencies for interprofessional education in the health professions, along with AACOM and other health professions associations and foundations that are part of the Interprofessional Education Collaborative.

The report also recommends that resident training transition from a system that is based on length of time in a residency program to one that is outcomes-based, with residency “complete” when the physician resident demonstrates standards-driven competencies that show he or she is prepared and ready for unsupervised practice. This recommendation aims to recognize differing rates of skills and competency acquisition among residents. According to the report, under the current system, “Residents who achieve competency more quickly than their peers must still complete the required period of training, which delays the ‘delivery’ of competent physicians into practice and underutilizes the available pool of GME positions, which is an important societal resource.”

View the full report to learn about more of the Macy Foundation’s recommendations and view a list of conference participants.

The most recent report follows, “Conference Summary: Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System,” published in October 2010 following the first conference to develop recommendations on the future of GME.

The Josiah Macy Jr. Foundation supports projects that broaden and improve health professional education.

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October 2011
Vol. 5, No. 10