From burnout to shortcomings in interprofessional training, everyone seems to agree that the resident experience is in need of improvement. But what would an ideal residency look like, and can that vision become reality?
The American Medical Association (AMA) recently awarded $14.4 million to support eight projects from various institutions through its "Reimagining Residency" grant program in an effort to improve residency training. The projects will create new curricula and draw upon recent innovations to potentially reimagine this crucial time in young doctors' lives. We spoke with some of the grant winners and asked them to share with us how their work will change the future of medical training and what they think residency will look like halfway through this century.
Lisa Willett, MD; and Stephen Russell, MD (The University of Alabama at Birmingham School of Medicine)
In the 1950s, Dr Tinsley Harrison wrote in the introduction to Harrison's Principles of Internal Medicine that a physician needs "technical skill, scientific knowledge, and human understanding" to care for patients. In 2050, at the 100th anniversary of those words, we envision an innovative training environment for graduating residents to meet those goals.
We aim for residents to gain cognitive and technical skills through competency-based training. Each resident should advance through training with personalized tailored feedback to improve based on directly observed skills. Resident advancement toward practice autonomy will be based on demonstrated expertise and not length of time in training.
We aim for residents to gain scientific knowledge combining time-honored techniques with modern medical advances. Using a team approach centered on patients' needs helps improve patient outcomes and drives evidence-based decision- making.
We aim for residents to gain human understanding by investing in the physician-patient relationship. Meaningful time in the presence of the patient brings meaning and purpose to this sacred encounter, ensuring that patients get the best possible care.
Reimagining residency for 2050 is based on the fundamental principle that joy in medical practice is experienced with our patients as we serve their needs. In doing so, residents will find that they are not only meeting the needs of a modern health system but also meeting their own professional needs.
The University of Alabama at Birmingham School of Medicine, Johns Hopkins University School of Medicine, and Stanford University School of Medicine were awarded an AMA grant for their project: The Graduate Medical Training "Laboratory": An Innovative Program to Generate, Implement, and Evaluate Interventions to Improve Resident Burnout and Clinical Skill.
Catherine C. Skae, MD, DSc (Montefiore Medical Center, Albert Einstein College of Medicine)
Because we can't predict how advances in technology or policy might change the practice of medicine in 2050, we don't really know what medical training will look like; however, we do know that the health of patients will always be impacted by social determinants of health (SDH). Thus, we can endeavor to change education in meaningful ways right now and into the future.
We firmly believe that residency in 2050 will ideally incorporate rigorous curricula on SDH that encompass both concrete, specific needs—such as inadequate food and transportation needs—and complex structural underpinnings that are mostly responsible for health inequities. Recognizing and engaging SDH is an important strategy for healthcare systems to improve outcomes and reduce disparities. In the context of value-based care, healthcare providers increasingly are given a mandate to identify SDH and partner with community-based organizations to address their patients' health. SDH affect patients' clinical outcomes and well-being and can also be associated with higher health care costs.
The importance of the physician's role in addressing SDH has been stressed by major national professional organizations. However, physicians are not formally trained to effectively respond. Our hopes for 2050 would ensure adequate training and changes in house officer behavior to improve patient outcomes.
Embedding teaching in the clinical learning environment would support residents in building pragmatic skills to address SDH during patient visits and through interprofessional panel management activities such as team-based care approaches and quality improvement. Residents will integrate strategies such as awareness of and leadership in health system initiatives and advocacy to serve as change agents for underlying systemic etiologies of SDH. A cross-specialty curricular framework will allow medical schools and health care systems to efficiently scale high-quality training in SDH, thereby shifting the culture of residency training to meet the need for a physician workforce well versed in these skills.
A high-quality curriculum in SDH honors the meaningful mission at the heart of physicians' work. Skills and confidence in addressing patients' SDH needs may positively impact work-related characteristics that affect physician burnout, such as a sense of value alignment with the organization's leadership, efficiency in teamwork, and reduced workplace chaos; and, as a result, improve physician wellness and professional fulfillment for faculty, residents, and graduates.
Montefiore Medical Center was awarded an AMA grant for its project: Residency Training to Effectively Address Social Determinants of Health: Applying a Curricular Framework Across Four Primary Care Specialties.
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Cite this: Residency 2050: What Is the Future of Medical Training? - Medscape - Oct 07, 2019.
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