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Accreditors target training gaps that contribute to burnout

Top leaders from across the continuum of medical education say it is time for the respective accrediting bodies in undergraduate, graduate and continuing medical education to work more closely together to improve the transitions between career stages and create physicians who are lifelong learners.

The calls for collaboration came during a session that was part of a daylong event celebrating the 75th anniversary of the Liaison Committee on Medical Education (LCME). The LCME—jointly sponsored by the AMA and the Association of American Medical Colleges—accredits medical education programs leading to the MD degree in the U.S. and Canada.

Need to reduce “traumatic” transitions

In addressing the room of medical school deans and faculty members, Tom Nasca, MD, CEO of the Accreditation Council for Graduate Medical Education (ACGME), pointed out that at every level—between collegiate education and undergraduate medical education, between UME and GME and between GME and practice—there are gaps between the knowledge base a trainee has built and the necessary skills to thrive at a given level. The consequences of the stress of those transitions are a significant concern, he said.

“We have the data that show that these transitions are tremendously traumatic. The largest number of suicides in graduate medical education occur in the first year of training or the first year of a fellowship,” Dr. Nasca said. “They’re traumatic and they are systematic. [They are] a microcosm of everything else with our trainees.”

The issue of stress and burnout also has a significant impact on professionalism across the continuum of education, Dr. Nasca believes.

“No matter what future we look at, there’s one truism that rings throughout. That is that we need to strengthen this inculcation of professional values so that the physician is insulated from the buffeting that will take place in the future, no matter what future develops,” Dr. Nasca said. “If we don’t think that this is going on right now, look at the burnout rates, and the kind of maladaptive behaviors that are seen from physicians who are subjected to these stresses. There’s just no question that professionalism has to be strengthened.”

Dr. Nasca advocated for shared evaluation tools that can create a portfolio for trainees from their undergraduate training through continuing medical education.

“We can’t do it on our own,” he said. “But it can’t be done without us. We have to do this. Leadership is required by our institutions in medicine, and certainly on the burnout issue the leadership of medicine is stepping up and doing that.”

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    The continuum of medical education should evolve to better foster an environment that creates lifelong learners, said Graham T. McMahon, MD, CEO of the Accreditation Council for Continuing Medical Education (ACCME). He highlighted four steps he views as key to such an evolution.

    Start with the outcome in mind. “Information transfer is not the currency of education anymore,” Dr. McMahon said. “It’s all about problem solving, intellectual capacity and bringing diverse talents. … The outcome in mind has to be essential and fundamental.”

    Be attentive to learning environments. “If you don’t feel that your learning environment is allied with you in developing your own professional growth, we’re in big trouble,” he said. “Why do so many of us come into a profession like this? Because we thrive when we are intellectually stimulated and are growing, changing and evolving.”

    Manage data across organizations. “Increasingly, learning outcomes and performance can be passively tracked by the environments we’re in,” Dr. McMahon said. “And that is useful for self-assessment and self-awareness. The more we inculcate self-awareness, the more likely we are to drive toward the closing of that gap between confidence and competence. Self-awareness is improved by data.”

    Make learning efficient, creative. “It’s just not enough to stand in front of an audience and deliver wisdom,” he said. “You have to create provocative problem-solving activities. You have to make learning efficient. That requires a whole series of demands on educators. That requires much greater degrees of sophistication amongst our faculty.”

    In addition to in-depth discussion about the future of accreditation and the numerous challenges facing physician education and training, the LCME anniversary event celebrated the release of “Academic Quality and Public Accountability in Academic Medicine: The 75-Year History of the LCME.” The 268-page book tells the history of the development of the current structure and functions of the LCME, and outlines the medical school accreditation process.

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