Innovative Practices Congruent With the First Goal of the IOM 2014 Report on Graduate Medical Education

摘要

In a News and Views piece entitled “ACGME Initiatives in Concert With Institute of Medicine Recommendations” in this issue of the Journal of Graduate Medical Education, Dr. Nasca lays out the current initiatives by the Accreditation Council for Graduate Medical Education (ACGME) in keeping with the aims of the Institute of Medicine (IOM) 2014 report entitled Graduate Medical Education That Meets the Nation's Health Needs.1 This brief companion article offers examples of existing initiatives in accredited programs that are in furtherance of the first goal in the IOM report, which is to “encourage production of a physician workforce better prepared to work in, help lead, and continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost.” The IOM committee's remaining goals provide recommendations for changing the financing and oversight of GME to better meet this first goal. The first goal explicitly references the Institute for Healthcare Improvement's Triple Aim framework for optimizing health system performance to focus on quality, safety, and value. The Triple Aim framework calls for the design of the health system to: Improve the patient experience of care (including quality and satisfaction); Improve the health of populations; and Reduce the per capita cost of health care.2 The IOM report provides general information on the types of projects the committee considered in keeping with the aims of the report (Box S-3, page 14). It does not include any concrete examples, noting that little work has been done to date to develop and test innovative approaches for organizing and deploying physicians in new models of care delivery, to encourage physicians trainees to enter the specialties and practice locations with the greatest need, and to provide residents with the skills set most relevant for their practice after graduation. The report notes the committee viewed the recommended GME innovation fund as a critical tool in promoting broader development and testing ofthese approaches. The examples in furtherance of the IOM's goal highlighted here are provided to show what is already feasible and being done in accredited programs, and to offer other programs ideas to consider for adoption or adaptation. The examples selected focus on readily implementable approaches that would benefit from further testing and assessment to begin the development of an evidence-based innovation in GME.;Existing Program Level-Initiatives in Furtherance of the “Triple Aim” Use of a Team Care Model in a Resident Clinic to Improve Continuity and Outpatient Care Efficiency Use of “patient care management teams” in a family medicine residency resulted in significant improvements in perceptions of continuity of patient care, office efficiency, and team communication, with improvement reported by trainees and in results for patient satisfaction. Reported as Hern T, Talen M, Babiuch C, Durazo-Arvizu R. Patient care management teams: improving continuity, office efficiency, and teamwork in a residency clinic. J Grad Med Educ. 2009;1(1):67–72.