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John Andrews, MD, vice president of GME Innovations at the AMA, joins to discuss the transition from undergraduate medical education to graduate medical education and how to prepare medical students for residency. Dr. Andrews points out the biggest pain points in the transition and the things incoming residents can do between medical school and residency to prepare to practice. AMA Chief Experience Officer Todd Unger hosts.
- Get more information on AMA's GME Competency Education Program (GCEP).
- Access undergraduate medical education resources via AMA's UME Curricular Enrichment Program.
- Learn more about AMA's work to accelerate change in medical education—or ChangeMedEd®️ Initiative.
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John Andrews, MD, vice president, GME Innovations, AMA
Unger: Hello, and welcome to the AMA Update video and podcast. Today we're on location at the AMA's ChangeMedEd conference in Chicago to discuss the transition from undergraduate medical education to graduate medical education and how to make it smoother for medical students and residents. Joining me today is Dr. John Andrews, the AMA's vice president of GME innovations. I'm Todd Unger, AMA's chief experience officer. John, welcome.
Dr. Andrews: Thanks, Todd. It's nice to be here with you in person at ChangeMedEd.
Unger: It's exciting to be here. John, I just want to start off for the folks out there in the audience to talk a little bit about this transition from UME to GME. There's always been some form of gap there. But when did you start to realize there was both kind of a problem and an opportunity there?
Dr. Andrews: Yeah, I think there's been heightened focus on the transition as a discontinuous part of physician professional development for about the last 5 to 10 years. And it's leading to a lot of innovative work, a lot of attention focused on that transition, as you said, to try to make it a smoother process.
Unger: Well, let's talk a little bit about that gap. What's at issue in there?
Dr. Andrews: I think there are a number of factors that are contributing to it. Students, to a degree, are somewhat less prepared for residency than they used to be because—it's no fault of theirs. They have more limited opportunities for independent clinical care of patients. There are a lot of reasons for that.
I think that there's much more anxiety about securing a residency position. And therefore, students, to some degree, are more focused on that than they are on their professional development as a physician. And perhaps as a result of that, there's less sharing of information from medical school to residency. And so the transition is a less well-informed process than it could be.
Unger: So obviously, that's going to create some issues for first-year residents and for program directors. Why do these gaps like that get ... are they not addressed?
Dr. Andrews: It does create problems for learners and for program directors. I think for program directors, it leads to it taking quite a long time for them to understand the particular skills and gaps in preparation that their interns bring to the table. And therefore, the mobilization of resources that might support that transition are delayed. And for the learners, when there isn't information shared, they know what their skills and gaps are. And it contributes to imposter syndrome when no one else knows. And they have to enter residency uncertain about whether they're going to be able to cope with what they're facing.
Unger: I think a lot about the world of experience. And when we think about problems that go unaddressed, a lot of times it's because there's a lack of clarity about who owns the problem. So in this case, is there a confusion? Is it the undergraduate institution or is it the graduate institution that bears responsibility for this gap?
Dr. Andrews: I think that's a complicated issue. There's shared responsibility for the transition. I think programs, to a degree, have a fantasy that medical students will be prepared to, essentially, act almost independently in the clinical environment when they arrive. And medical schools think that their responsibility is to provide a basic foundational set of skills to students, and then the real clinical training will take place in residency when they get there.
And so I think there's some shared responsibility for medical schools to better prepare students for residency and for residencies to have realistic expectations about what their responsibility is to upskill their residents once they arrive.
Unger: Now, you and the team, MedEd team here at the AMA, been working in this realm for some period of time. And one of the concepts you've been working on is this idea of targeted coaching that begins in medical school. Tell us a little bit more about that concept. What's it entail?
Dr. Andrews: Yeah, we talk a lot about that. It's an opportunity for active self-reflection on the part of a learner for them to better understand where their skills lie, what their gaps in preparation may be, and then receive some guidance about the best way to address those gaps to foster their professional development.
We talk a lot about the concept of the master adaptive learner, which is really a learning PDSA cycle where you identify gaps in your preparation. You take advantage of experiences to address those gaps. And then you repeat that cycle throughout your career to make sure that you're advancing and providing the best care possible to your patients.
Unger: Now, on that GME side, you've talked about the importance of specialty-specific kind of just-in-time coaching. What is that?
Dr. Andrews: So when you enter a residency, that's a specialty training experience. And there are certain baseline skills that you probably need to effectively navigate the environment that you're working in when you arrive. And there have been various approaches to it. Some specialties literally have boot camps. General surgery, for example, will send people off before their internship begins to a boot camp to assemble that basic set of skills that will ensure success in residency.
Now, the nature of those specialty-specific skills is different if you're training in surgery versus internal medicine. Some medical schools have developed preparation for residency courses that take advantage of the time between the match and beginning internship to provide some of those skills to their graduates. So once again, it's a shared responsibility. But it's a way of addressing the gaps in preparation that learners may have to more effectively begin residency feeling confident.
Unger: That's great. As you think, again, back to that transition point, orientation, which is you talked about you've got a boot camp in one regard to get people into that new world. But in the world of orientation, that's another thing that we've been working on at the AMA. And we've begun to build courses out in our GME Competency Education Program that speak to some of these orientation needs. What are the things that need to get taught in that orientation coursework?
Dr. Andrews: So when you arrive, in addition to some of the clinical skills that we've talked about, you're working in a new environment as an employee. And so understanding the health system and the context for the care that you're providing is really important.
And orientation has a lot to do with that. I mean, it's about getting your ID and finding where the bathrooms are and that sort of thing. But it's also about effective electronic medical record documentation and other things that go into the delivery of care.
Where the GCEP program is concerned, there are certain things related to that residency experience, how you manage sleep deprivation, how you work in interprofessional teams, cultural issues in the delivery of care. And GCEP has evolved some modules to assist learners in a self-directed way to address some of those perceived gaps in their preparation and address them independently, which is nice.
Unger: You can really feel the excitement in the air at this conference. Tell us a little bit about how smoothing this transition, which is obviously a big focus here, is going to have an impact beyond to the training of the folks.
Dr. Andrews: Yeah, well, right now it's so discontinuous. And you graduate from medical school and then start again in residency. And that leads to some backtracking. If we can make this process smoother, it'll actually accelerate the development of our physicians, make them feel more confident and allow them to focus on very specific specialty-skill areas sooner in their training. So it's really more about efficiency than it is about that gap between medical school and residency.
Unger: I just—I love everything you're talking about and just creating a continuum as opposed to starting over again. It's just such an amazing pursuit. And what an impact it's going to have on future generations. Dr. Andrews, thank you for being here today. And thanks to the whole MedEd team at the AMA and all the partners that you are working with out there on this particular project.
And for those who are interested in learning more about the work that the AMA is doing in this space and specifically about our new orientation curriculum and transition program within GCEP, visit edhub.ama-assn.org/gcep. That URL will be in the description of this episode. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.