Move to align GME accreditation paves way for “ideal” continuum


With a “strong affirming vote” from the American Osteopathic Association (AOA) House of Delegates, the plan to implement a single accreditation system for all U.S. graduate medical education (GME) programs moves forward, a significant step in efforts to create an ideal medical education continuum.

The shift to a single GME accreditation system will provide “the greatest opportunity for optimization of use of the GME resources provided by the public to the profession and maximizes opportunities for the residents of today and tomorrow,” Thomas J. Nasca, MD, CEO of the Accreditation Council of Graduate Medical Education (ACGME) said in a July 19 letter.

The accreditation of allopathic and osteopathic medical education has largely followed separate paths, according to a new report from the AMA Council on Medical Education that explores some principles for an ideal medical education continuum.

Although standards for undergraduate medical education and GME have evolved independently over time, it isn’t that unusual for learners to move from osteopathic colleges to ACGME-accredited residency programs. In 2012, for example, 8 percent of residents enrolled in ACGME-accredited and specialty GME programs were osteopathic medical college graduates.

With the recently confirmed agreement between the AOA, ACGME and the American Association of Colleges of Osteopathic Medicine to move osteopathic GME accreditation in line with ACGME accreditation, all U.S. medical school graduates will be eligible for all residency positions, whether they hold an MD or DO degree.

The Council on Medical Education report discussed how to support a medical education continuum, which would follow a learner from premedical education through medical school and residency training and into practice. “In the ideal continuum, there is coordination of the processes for both the accreditation of educational programs and the assessment of learners,” the AMA council report states.

An aligned learning continuum is challenging to achieve because it requires cooperation across all the phases of physicians’ training to create and implement:

  • Agreed-upon, outcomes-based competencies: The ACGME’s six competency domains are widely accepted as a way to ensure residency training assesses learners on key areas of competence. Many medical schools also have adopted these competencies, and the language of the competencies offers a framework for other educational programs.
  • Benchmarks for progression: The ACGME is implementing its Next Accreditation System, which will shift program accreditation to a more continuous, quality improvement model. As part of this system, the ACGME has created specialty-specific milestones that reflect the trajectory of professional development. Medical schools can use these milestones to create competencies for medical students, such as the Association of American Medical Colleges’ core entrustable professional activities, which provide a framework  to assess whether a learner can be trusted to competently perform an activity. For example, a student would have to demonstrate that he or she could develop a prioritized differential diagnosis and select a working diagnosis following a patient encounter, and would be evaluated on whether that student could be trusted to appropriately perform that activity without supervision.
  • Processes and tools for education and assessment: Some of the schools in the AMA’s Accelerating Change in Medical Education initiative are working on digital portfolios that will follow learners from medical school through residency into private practice. With such tools, learners and mentors can track competency growth over time.

The AMA will work with other relevant associations and accreditation bodies to develop strategies that will help reach the ideal medical education continuum. This includes identifying areas in which accreditation standards overlap between medical school and residency, and creating a standardized method of feedback from medical school to premedical institutions and from residency programs to medical schools about their graduates’ preparedness for entry.