At the Intersection of Health, Health Care and Policy Cite this article as: Stephen C. Shannon, Boyd R. Buser and Marc B. Hahn Graduate Medical Education: The Authors Reply Health Affairs, 33, no.6 (2014):1102 doi: 10.1377/hlthaff.2014.0393
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 20, 2015 at The University of Iowa Libraries
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doi:
10.1377/hlthaff.2014.0393
Graduate Medical Education: The Authors Reply Since the publication of our article (Nov 2013), we have received much feedback from the medical community (including Grant Hoekzema’s letter). The feedback has primarily focused on the length of training required to produce a competent primary care physician and the implications of the announced creation of a single, unified graduate medical education (GME) accreditation system by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association. Our article included recommendations to develop a competency-based curriculum and to create a longitudinal educational experience that would be based on an integrated curriculum with a seamless transition between undergraduate and graduate medical education. We believe that these two recommendations and others included in the article would make it possible to eliminate redundancies and inefficiencies in the current education and training model and would result in cost reductions and time savings. However, saving time was not our primary focus; instead, the development of a competency-based integrated educational experience was. By definition, a competency-based curriculum delinks the length of training from the achievement of educa-
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tion milestones and readiness for practice. We believe that students should progress only when they have demonstrated competency in a specific area. Any time savings envisioned do not necessarily equate to shortened training. Many authoritative bodies that we cited in our article have called for the streamlining of physician education.We believe that new competencies, coupled with the personal learning variability needed in a competency-based system, would result in a range of needed training times, which are yet to be determined. The implications of unified GME accreditation are also unknown. In today’s system, the regulatory processes used by accrediting bodies for graduate medical education—as well as those used for medical school accreditation and board certification—will clearly affect the ability to implement competency-based and other innovations in medical education. Stephen C. Shannon American Association of Colleges of Osteopathic Medicine CHEVY CHASE , MARYLAND Boyd R. Buser University of Pikeville PIKEVILLE , KENTUCKY Marc B. Hahn Kansas City University of Medicine and Biosciences KANSAS CITY , MISSOURI
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/6/1102.2.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on June 20, 2015 at The University of Iowa Libraries
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2014.0393
Graduate Medical Education: The Authors Reply Since the publication of our article (Nov 2013), we have received much feedback from the medical community (including Grant Hoekzema’s letter). The feedback has primarily focused on the length of training required to produce a competent primary care physician and the implications of the announced creation of a single, unified graduate medical education (GME) accreditation system by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association. Our article included recommendations to develop a competency-based curriculum and to create a longitudinal educational experience that would be based on an integrated curriculum with a seamless transition between undergraduate and graduate medical education. We believe that these two recommendations and others included in the article would make it possible to eliminate redundancies and inefficiencies in the current education and training model and would result in cost reductions and time savings. However, saving time was not our primary focus; instead, the development of a competency-based integrated educational experience was. By definition, a competency-based curriculum delinks the length of training from the achievement of educa-
1102
Health Affairs
J u n e 201 4
tion milestones and readiness for practice. We believe that students should progress only when they have demonstrated competency in a specific area. Any time savings envisioned do not necessarily equate to shortened training. Many authoritative bodies that we cited in our article have called for the streamlining of physician education.We believe that new competencies, coupled with the personal learning variability needed in a competency-based system, would result in a range of needed training times, which are yet to be determined. The implications of unified GME accreditation are also unknown. In today’s system, the regulatory processes used by accrediting bodies for graduate medical education—as well as those used for medical school accreditation and board certification—will clearly affect the ability to implement competency-based and other innovations in medical education. Stephen C. Shannon American Association of Colleges of Osteopathic Medicine CHEVY CHASE , MARYLAND Boyd R. Buser University of Pikeville PIKEVILLE , KENTUCKY Marc B. Hahn Kansas City University of Medicine and Biosciences KANSAS CITY , MISSOURI
3 3: 6
Downloaded from content.healthaffairs.org by Health Affairs on June 20, 2015 at The University of Iowa Libraries
