Care will be safe, high quality, and humanistic. It will reflect the highest professional values, including self-effacement, appreciating medicine’s inherent fundamental ethical core, and its public responsibility and accountability. It will be based on information-technology literacy, involving patients in their own care, and the use of health information technology to improve outcomes for individuals and populations. Residents and/or fellows will be trained to have the knowledge and skills essential to function as experts. They will be team oriented. They will have leadership skills. They will perform critical self-analysis. They will measure what they do. They will optimally manage transitions of care. They will communicate excellently and professionally. They will engage in continued study. They will practice medicine in a manner conducive to delivery of high-value, cost-effective, cost-conscious, safe, timely, efficient, equitable, patient-centered, ethical, and humanistic care. This will be expected by society. Graduate medical education (GME) will be a critical, if not key, influence in training doctors with these skills requisite for tomorrow’s physicians.1-4
Personal Comments and Thoughts
Whew. That’s a lot, summarized as best and as concisely as I can, and without describing all the attendant infrastructure, particular expectations, new processes and requirements, and annual reporting. Doesn’t it sound good? I laud colleagues at the ACGME, many of whom I have come to know and respect over the years, for their vision. It reflects many of my values and perceptions for contemporary medicine. But I have concerns here. I have been intimately involved with education and training of students, residents, and fellows during my entire career. I do it because it’s important, worthwhile, satisfying, “generative,” and fun. I worry that the NAS will not necessarily be these.
Emperor Joseph II said to Mozart, after hearing “The Abduction from the Seraglio,” which he had commissioned, “there are simply too many notes … just cut a few and it will be perfect.” I worry that accreditation will still be too complex, that preoccupation with details will impede realization of the overall goals, that new processes are substituted for old, not lessened—that there are too many notes. I worry that the NAS will be expensive and burdensome, probably more than the “old” system; that’s what my colleagues in medicine—where it has already begun—tell me. I worry that academic medicine will (continue to) invest enormous time and effort with this, more than I would wish. I worry that regulatory agencies aren’t the best agents for change; regulators regulate. I worry that regulatory concerns will predominate over aspirational outcomes. Some will worry about incentives to perpetuate the GME regulatory enterprise. I worry that one of the changes predicted for the future of medicine—“plasticity” of regulatory authorities—isn’t apparent here.5 I worry that, just as there is finally recognition of the need to minimize excessive costs in healthcare, so too should there be attention to reducing and streamlining medical and postgraduate medical education and training.6
