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REPORT URGES COMPLETE RESIDENCY OVERHAUL

Publish date: August 31, 2021
By Ken Terry





The transition from undergraduate medical education (UME) to graduate medical
education in the United States needs comprehensive reform, says a new report
from the Graduate Medical Education Review Committee (UGRC) of the Coalition for
Physician Accountability.

The 275-page report presents preliminary findings that were released in April
2021 and a long list of stakeholder comments. According to the report, the
coalition will meet soon to discuss the final recommendations and consider next
steps toward implementation.

The UGRC includes representatives of national medical organizations, medical
schools, and residency programs. Among the organizations that participated in
the report’s creation are the American Medical Association, the National Board
of Medical Examiners, the American Osteopathic Association, the National Board
of Osteopathic Medical Examiners, the Educational Commission for Foreign Medical
Graduates, and the Association of American Medical Colleges.



The report identifies a list of challenges that affect the transition of medical
students into residency programs and beyond. They include:

 * Too much focus on finding and filling residency positions instead of
   “assuring learner competence and readiness for residency training”
 * Inattention to assuring congruence between applicant goals and program
   missions
 * Overreliance on licensure exam scores rather than “valid, trustworthy
   measures of students’ competence and clinical abilities”
 * Increasing financial costs to students
 * Individual and systemic biases in the UME-GME transition, as well as
   inequities related to international medical graduates


SEEKING A COMMON FRAMEWORK FOR COMPETENCE

Overall, the report calls for increased standardization of how students are
evaluated in medical school and how residency programs evaluate students. Less
reliance should be placed on the numerical scores of the U.S. Medical Licensing
Examination (USMLE), the report says, and more attention should be paid to the
direct observation of student performance in clinical situations. In addition,
the various organizations involved in the UME-GME transition process are asked
to work better together.

To develop better methods of evaluating medical students and residents, UME and
GME educators should jointly define and implement a common framework and set of
competencies to apply to learners across the UME-GME transition, the report
suggests.

While emphasizing the need for a broader student assessment framework, the
report says, USMLE scores should also continue to be used in judging residency
applicants. “Assessment information should be shared in residency applications
and a postmatch learner handover. Licensing examinations should be used for
their intended purpose to ensure requisite competence.”

Among the committee’s three dozen recommendations are the following:

 * The Centers for Medicare & Medicaid Services should change the GME funding
   structure so that the initial residency period is calculated starting with
   the second year of postgraduate training. This change would allow residents
   to reconsider their career choices. Currently, if a resident decides to
   switch to another program or specialty after beginning training, the hospital
   may not receive full GME funding, so may be less likely to approve the
   change.
 * Residency programs should improve recruitment practices to increase
   specialty-specific diversity of residents. Medical educators should also
   receive additional training regarding antiracism, avoiding bias, and ensuring
   equity.
 * The self-reported demographic information of applicants to residency programs
   should be measured and shared with stakeholders, including the programs and
   medical schools, to promote equity. “A residency program that finds bias in
   its selection process could go back in real time to find qualified applicants
   who may have been missed, potentially improving outcomes,” the report notes.
 * An interactive database of GME program and specialty track information should
   be created and made available to all applicants, medical schools, and
   residency programs at no cost to applicants. “Applicants and their advisors
   should be able to sort the information according to demographic and
   educational features that may significantly impact the likelihood of matching
   at a program.”


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