AMA Initiative to Transform Medical Education SACME October 28, 2006

1
AMA Initiative to Transform Medical
EducationSACME October 28, 2006

• Barbara Schneidman, MD, MPH
• Vice President, Medical Education
• American Medical Association

2
Session Overview

• Describe the ITME goal and process
• Describe problem areas/gaps in physician
  preparation identified at the December 2005 ITME
  Working Meeting and in national reports
• Discuss Second Working Conference Held
  September 2006

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ITME Goal

• Promote excellence in patient care
• by implementing reforms
• in the medical education and training system
• across the continuum
• from pre-medical preparation
• and medical school admission
• through
• continuing physician professional development

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ITME LEADERSHIP GROUP

• Carl A Sirio, MD, Chair (Council on Medical
  Education)
• Peter W Carmel, MD (Board of Trustees)
• Emmanuel G Cassimatis, MD (Council on Medical
  Education)
• Kelly Caverzagie, MD (Resident/Fellow Section)
• Ann C Jobe, MD, MSN (Section on Medical Schools)
• Michael Katz (Medical Student Section)
• Nancy Nielsen, MD, PhD (Board of Trustees)
• Modena H Wilson, MD, MPH (Senior Vice President,
  Professional Standards)

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ITME Process
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Phase 1December 2005 Working Meeting

• Informed by review of 14 national reports
  published since 2000
• Participants came from the following stakeholder
  groups
• Provider organizations and groups
• Purchasers
• Government
• Consumer groups/public
• Accrediting/certifying/licensing bodies
• Medical educators/researchers

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Outcomes of December 2005Working Meeting

• List of current strengths in the preparation of
  physicians
• List of problem areas related to physicians
  preparation to
• Function in the health care system
• Interact with patients
• Act as caring professionals in society

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Strengths in Physician Preparation

• Physicians are knowledgeable and technically
  proficient in providing care for acute
  conditions
• Physicians have a strong commitment to the care
  of their patients
• Physicians are respected as credible sources of
  information by patients/the public

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Categories of Gaps/Problem Areasin Physician
Preparation

• Diagnosing and treating problems in their own
  health care setting and in the health care system
• Serving as advocates for patients
• Losing altruism and the caring aspects of
  medicine
• Dealing with uncertainty
• Managing information
• Expecting to be autonomous/function independently
• Balancing the individual and population
  perspectives
• Exercising skills in patient communication

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Validating the Gaps/Problem Areas

• Shared the conference summary with meeting
  participants for their feedback
• Presented the results to various groups, for
  example- At an Education Forum during the June
  2006 AMA Annual Meeting- At a meeting of
  the Accreditation Council for Continuing
  Medical Education
• As a result, created a revised list of
  gaps/problem areas. September conference looked
  at these 11 problem areas.

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Ability to Diagnose and Treat Health System
Problems

• Ability to engage in continuous quality
  improvement approach to system evaluation at the
  macro (health system) level
• Ability to evaluate own practices and use the
  results to improve quality and safety

12
Patient Advocacy

• Preparation to be advocates for patients related
  to issues of social justice (e.g., elimination of
  health care disparities, access to care)
• Willingness/ability to be citizen leaders inside
  and outside of the medical profession
• Willingness/ability to engage in advocacy on
  public health issues

13
Losing Altruism and the Caring Aspects of Medicine

• Loss of qualities of caring as physicians proceed
  through training
• Perceiving patients as problems to be solved,
  instead of individuals in need

14
Dealing with Uncertainty

• Physicians are trained to believe that it is
  important to have the answer, leading to
• discomfort dealing with incomplete or conflicting
  information
• difficulty conveying uncertainty to patients

15
Managing Information

• Physicians may not be prepared to utilize
  information technology
• to assist in identifying current information
• to apply in the context of care of a specific
  patient
• Physicians are not prepared to create
• their own lifelong learning curriculum

16
Physicians are Socialized to Desire and Expect
Autonomy

• Physicians expect to be in charge, which could
  impact ability to deliver patient-centered care
• Physicians are not prepared to be team players
  with other physicians and health professionals
• Physicians expectation of autonomy is in
  contrast to increased demands for accountability
  and transparency

17
Balancing the Individual Patient and Population
Perspectives

• While physicians are prepared to do what they
  believe is best for individual patients, they
  often are not equally well prepared to exercise a
  population-based perspective

18
Exercising Skills in Communicating with Patients

• Physicians need additional preparation in
  communicating with patients about difficult
  issues, such as death and dying.
• There is a need to expand skills in cultural
  competence/awareness, including recognizing
  health literacy issues.
• Physicians are not comfortable discussing errors
  in patient care

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Lack of Flexibility in Career Paths

• Once training has been completed in a specialty,
  it is difficult for physicians to make mid-career
  adjustments

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Phase 2 Developing Strategiesfor Change

• What should be changed in medical education to
  remedy the problem areas?
• Where in the continuum of medical education
  should change occur?
• What will support the change and what are the
  barriers to change occurring?
• What groups need to be involved to bring change
  about?

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CONSENSUS

• Recruit medical students with capacity of
  life-long learning, self-reflection and emotional
  intelligence.
• Encourage team-building within medicine and
  across disciplines and professions.
• Implement new evaluation models, including 360
  evaluations, team grades and self appraisals.

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CONSENSUS cont.

• Promote faculty development to mentor these
  qualities.
• Inculcate and reward curiosity, humility and
  humanistic values.

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THANK YOU

• THINK MUCH,
  
• PUBLISH LITTLE.
• Abraham
  Flexner