Graduate Medical Education

General Medicine ◽

Medical Specialty ◽

Medical Schools ◽

University Hospital ◽

Graduate Medical ◽

Interns And Residents

Graduate medical education has become as important as attendance at medical school in the training of physicians. Up to 1970, most graduates of medical schools first took an internship in general medicine and then a residency in a specialty. After 1970, practically all medical school graduates entered residency training in a specialty immediately after graduation. Residency programs have been located in hospitals affiliated with medical schools and have been accredited by specialty boards, which have been controlled by medical school faculty members. This situation has led to insufficient breadth of training and lax regulation of the programs. The internship, which followed graduation from medical school until its elimination after 1970, consisted of one or two years of hospital training, usually unconnected with any medical specialty. It was designed to provide gradually increasing responsibility for patient care, supplemented by formal teaching in rounds and seminars. In practice, as George Miller observed in 1963, it was “virtually impossible to find an internship [program with] a graded and sequential course of study leading to relatively well-defined goals.” This was also the finding of several surveys of interns and physicians. A 1959 survey of 2,616 interns found that the two most frequently cited deficiencies of internships were lack of “sufficient review and criticism of your work with patients,” cited by 47 percent, and “adequate instruction in the application of scientific knowledge to patient care,” cited by 34 percent. A 1952 survey of 6,662 graduates of the medical school classes of 1937 and 1947 and a later survey of over 3,000 interns and residents produced similar findings. Formal instruction during the internship was usually casual and unsystematic. Stephen Miller's study of one university hospital found that interns spent only a few hours per week in formal lectures and conferences and on rounds. In teaching on rounds, “the visiting physician does not prepare a lecture or other teaching material. He simply walks onto the ward and responds to patients and their problems with opinions and examples from his own clinical experience.” The educational value of rounds therefore depended on the illnesses of the patients and the relevant skills of the physicians.

From Medical School to Residency: Transitions During the COVID-19 Pandemic

10.4300/jgme-d-20-00627.1 ◽

2020 ◽

Vol 12 (4) ◽

pp. 507-511

Author(s):

Lauren M. Byrne ◽

Eric S. Holmboe ◽

John R. Combes ◽

Thomas J. Nasca

Keyword(s):

Medical Education ◽

Medical School ◽

Medical Schools ◽

The United States ◽

Residency Programs ◽

Graduate Medical ◽

Time Period ◽

Policies And Procedures ◽

Academic Year

ABSTRACT Background The start of a new academic year in graduate medical education will mark a transition for postgraduate year 1 (PGY-1) residents from medical school into residency. The relocation of individuals has significant implications given the COVID-19 pandemic and variability of the outbreak across the United States, but little is known about the extent of the geographic relocation taking place. Objective We reported historical trends of PGY-1 residents staying in-state and those starting residency from out-of-state to quantify the geographic movement of individuals beginning residency training each year. Methods We analyzed historical data collected by the Accreditation Council for Graduate Medical Education in academic years 2016–2017, 2017–2018, and 2018–2019, comparing the locations of medical school and residency programs for PGY-1 residents to determine the number of matriculants from in-state medical schools and out-of-state medical schools. International medical school graduates (IMGs) were shown separately in the analysis and then combined with out-of-state matriculants. US citizens who trained abroad were counted among IMGs. Results The total number of PGY-1s increased by 10.3% during the 3-year time period, from 29 338 to 32 348. When combined, IMGs and USMGs transitioning from one state or country to another state accounted for approximately 72% of PGY-1s each year. Approximately 63% of USMGs matriculated to a residency program in a new state, and IMGs made up 24.6% to 23.1% of PGY-1s over the 3-year period. Conclusions Each year brings a substantial amount of movement among PGY-1s that highlights the need for policies and procedures specific to the COVID-19 pandemic.

The Role of the Medical School in Rural Graduate Medical Education: Pipeline or Control Valve?

The Journal of Rural Health ◽

10.1111/j.1748-0361.2000.tb00468.x ◽

2000 ◽

Vol 16 (3) ◽

pp. 249-253 ◽

Cited By ~ 35

Author(s):

Howard K. Rabinowitz ◽

Nina P. Paynter

Keyword(s):

Medical Education ◽

Medical School ◽

Control Valve ◽

Graduate Medical ◽

Education Pipeline

How medical school did and did not prepare me for graduate medical education

Academic Medicine ◽

10.1097/00001888-198609000-00002 ◽

1986 ◽

Vol 61 (9) ◽

pp. 3-10

Author(s):

C M Mangione

Keyword(s):

Medical Education ◽

Medical School ◽

Graduate Medical

Toward a New Paradigm in Graduate Medical Education in the United States: Elimination of the 24-Hour Call

10.4300/jgme-d-09-00061.1 ◽

2009 ◽

Vol 1 (2) ◽

pp. 188-194 ◽

Cited By ~ 5

Author(s):

Susan G. Mautone

Keyword(s):

Medical Education ◽

Patient Care ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Near Misses ◽

Scheduling System ◽

Duty Hours ◽

Graduate Medical ◽

Vehicle Accidents

Abstract Background Sleep deprivation negatively affects resident performance, education, and safety. Concerns over these effects have prompted efforts to reduce resident hours. This article describes the design and implementation of a scheduling system with no continuous 24-hour calls. Aims included meeting Accreditation Council for Graduate Medical Education work hour requirements without increasing resident complement, maximizing continuity of learning and patient care, maintaining patient care quality, and acceptance by residents, faculty, and administration. Methods Various coverage options were formulated and discussed. The final schedule was the product of consensus. After re-engineering the master rotation schedule, service-specific conversion of on-call schedules was initiated in July 2003 and completed in July 2004. Annual in-training and certifying examination performance, length of stay, patient mortalities, resident motor vehicle accidents/near misses, and resident satisfaction with the new scheduling system were tracked. Results Continuous 24-hour call has been eliminated from the program since July 2004, with the longest assigned shift being 14 hours. Residents have at least 1 free weekend per month, a 10-hour break between consecutive assigned duty hours, and a mandatory 4-hour “nap” break if assigned a night shift immediately following a day shift. Program-wide, duty hours average 66 hours per week for first-year residents, 63 hours per week for second-year residents, and 60 hours per week for third-year residents. Self-reported motor vehicle accidents and/or near misses of accidents significantly decreased (P < .001) and resident satisfaction increased (P = .42). The change was accomplished at no additional cost to the institution and with no adverse patient care or educational outcomes. Conclusions Pediatric residency training with restriction to 14 consecutive duty hours is effective and well accepted by stakeholders. Five years later, the re-engineered schedule has become the new “normal” for our program.

Patterns of Change in ACGME-Accredited Residency Programs and Positions: Implication for the Adequacy of GME Positions and Supply of Physicians in the United States

10.4300/jgme-d-14-00140.1 ◽

2014 ◽

Vol 6 (2) ◽

pp. 399-403 ◽

Cited By ~ 7

Author(s):

Kathleen D. Holt ◽

Rebecca S. Miller ◽

Ingrid Philibert ◽

Thomas J. Nasca

Keyword(s):

Medical Education ◽

Medical School ◽

Primary Care Physicians ◽

Population Data ◽

The United States ◽

Graduate Medical ◽

The Past ◽

Accredited Institutions ◽

The Impact

Abstract Background Recent studies suggest that the supply of primary care physicians and generalist physicians in other specialties may be inadequate to meet the needs of the US population. Data on the numbers and types of physicians-in-training, such as those collected by the Accreditation Council for Graduate Medical Education (ACGME), can be used to help understand variables affecting this supply. Objective We assessed trends in the number and type of medical school graduates entering accredited residencies, and the impact those trends could have on the future physician workforce. Methods Since 2004, the ACGME has published annually its data on accredited institutions, programs, and residents to help the graduate medical education community understand major trends in residency education, and to help guide graduate medical education policy. We present key results and trends for the period between academic years 2003–2004 and 2012–2013. Results The data show that increases in trainees in accredited programs are not uniform across specialties, or the types of medical school from which trainees graduated. In the past 10 years, the growth in residents entering training that culminates in initial board certification (“pipeline” specialties) was 13.0%, the number of trainees entering subspecialty education increased 39.9%. In the past 5 years, there has been a 25.8% increase in the number of osteopathic physicians entering allopathic programs. Conclusions These trends portend challenges in absorbing the increasing numbers of allopathic and osteopathic graduates, and US international graduates in accredited programs. The increasing trend in subspecialization appears at odds with the current understanding of the need for generalist physicians.

Use of an Institutional Template for Annual Program Evaluation and Improvement: Benefits for Program Participation and Performance

10.4300/jgme-d-10-00002.1 ◽

2010 ◽

Vol 2 (2) ◽

pp. 160-164 ◽

Cited By ~ 6

Author(s):

Kathryn M. Andolsek ◽

Alisa Nagler ◽

John L. Weinerth

Keyword(s):

Medical Education ◽

Program Evaluation ◽

Tracking System ◽

University Hospital ◽

Improvement Strategy ◽

Meaningful Improvement ◽

Graduate Medical ◽

Program Adherence ◽

Duke University

Abstract Purpose The Accreditation Council for Graduate Medical Education (ACGME) expects programs to engage in ongoing, meaningful improvement, facilitated in part through an annual process of program assessment and improvement. The Duke University Hospital Office of Graduate Medical Education (OGME) used an institutional practice-based learning and improvement strategy to improve the annual evaluation and improvement of its programs. Methods The OGME implemented several strategies including the development and dissemination of a template for the report, program director and coordinator development, a reminder and tracking system, incorporation of the document into internal reviews, and use of incentives to promote program adherence. Results In the first year of implementation (summer 2005), 27 programs (37%) submitted documentation of their annual program evaluation and improvement to the OGME; this increased to 100% of programs by 2009. A growing number of programs elected to use the template in lieu of written minutes. The number of citations related to required program review and improvement decreased from 12 in a single academic year to 3 over the last 5 years. Conclusion Duke University Hospital's institutional initiative to incorporate practice-based learning and improvement resulted in increased documentation, greater use of a standardized template, fewer ACGME-related citations, and enhanced consistency in preparing for ACGME site visits.

Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies

10.4300/jgme-d-11-00058.1 ◽

2012 ◽

Vol 4 (2) ◽

pp. 176-183 ◽

Cited By ~ 7

Author(s):

Lourdes R. Guerrero ◽

Susan Baillie ◽

Paul Wimmers ◽

Neil Parker

Keyword(s):

Medical Education ◽

Los Angeles ◽

Patient Care ◽

Role Models ◽

Monitoring And Evaluation ◽

Learning Activities ◽

Web Based ◽

Residency Programs ◽

Graduate Medical

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies. Objective To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies. Method A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition. Results We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%–82%). Most residents (80%–97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies. Conclusion Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.