Since the July 2014 release of the Institute of Medicine’s report calling for a more publicly accountable graduate medical education (GME) system, the report has sparked an often contentious discourse among stakeholders about who wins and who loses. Because of the political difficulty in making any changes at this time, little is happening at the federal level on GME. Yet the case for GME reform made in the IOM report, and in earlier reports from the Josiah Macy Jr. Foundation that examine the future of GME, remains as strong as ever.
While, ultimately, we will likely need change in federal legislation, it’s clear that we can’t wait for the federal government to act if we want to truly reform and improve today’s GME system. The good news is that many GME programs, health care systems, and states are heeding the calls for reform made in the IOM and Macy Foundation reports.
That’s why the Macy Foundation will cohost and support a series of conferences on GME reform starting in February and running through May 2016. We are joining with leading academic institutions in six locations around the country to tap into the energy that’s in the field now by giving health professions leaders, educators, and medical residents an opportunity to showcase innovations in their localities and see what models are emerging that show the greatest promise for scale and spread.
The Macy Regional Conferences on Innovation in GME will be cosponsored by Vanderbilt University in Nashville, Tennessee; MD Anderson Cancer Center and the University of Texas System in Houston, Texas; University of California, San Francisco; University of Washington and the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Regional Medical Education program in Spokane; Partners Healthcare in Boston, Massachusetts; and the University of Michigan in Ann Arbor.
Each of the six will shape their own agenda and decide what kinds of innovations they want to illuminate from their region that focus on the structure, content, and financing of GME. All will have an opportunity to highlight pioneering models being developed locally or regionally that could help us achieve a more accountable GME system that is more aligned with the public’s health needs. Our aim with these conferences is to promote continued discussions about how to best reform and improve today’s GME system throughout the country through initiatives being developed and implemented at the local and regional levels.
Examples of what we’re hoping to learn more about include how new GME slots are being created through state or health system funding; how new relationships between medical schools and hospitals that had not previously had GME programs are forming; promising programmatic innovations such as introduction of new content and new program design; models of new and creative training sites for GME that provide needed competencies for practice in today’s health care system; innovative new payment mechanisms for GME; and promising new tools to assess competencies.
The conferences also will focus on both the barriers that stand in the way of innovation and the opportunities for additional innovations. At the culmination of the series, the Macy Foundation will issue a final report that captures this learning to help spotlight opportunities for replication and further innovation across the country. The Macy Foundation is pleased that the Accreditation Council for Graduate Medical Education (ACGME) is supportive of this initiative, will have representatives at each of the conferences, and will help disseminate the findings.
As a key sponsor of the IOM report and a foundation that has spent the past several years investing in efforts to foster a more accountable GME system that is more aligned with health care delivery, we view these regional conferences as a great opportunity to keep the momentum going and to advance reforms at the local and regional levels.
We realize that changes will also be needed at the federal level for effective GME reform. But that is going to take time. In the interim, we should be celebrating the innovation that’s occurring now and sharing those lessons to bring about changes and improvements in GME that are needed to better align GME with contemporary needs.
Institute of Medicine, “Graduate Medical Education That Meets the Nation’s Health Needs” (report brief), July 2014.
Josiah Macy Jr. Foundation, Ensuring an Effective Physician Workforce for the United States: Recommendations for Graduate Medical Education to Meet the Needs of the Public, November 2011.
Josiah Macy Jr. Foundation, Ensuring an Effective Physician Workforce for America: Recommendations for an Accountable Graduate Medical Education System, April 2011 (revised November 2011).