Transforming Graduate Medical Education to Improve Health Care Value

Hackbarth, Glenn; Boccuti, Cristina

doi:10.1056/nejmp1012691

Cited by 58 publications

(37 citation statements)

References 2 publications

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“…1 Medical education plays a key role in training the future physician workforce to be good stewards of health care resources. [2][3][4][5] The Accreditation Council for Graduate Medical Education (ACGME) has taken several steps to improve residency training in cost-conscious care.…”

Section: Introductionmentioning

confidence: 99%

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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BACKGROUND:Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE: We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in costconscious care impacted responses. DESIGN: Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently rolemodel cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS: Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES: The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS: Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently rolemodeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in costconscious care did not have a significant impact on survey responses (odds ratio [OR] were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in costconscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

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Section: Introductionmentioning

confidence: 99%

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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“…Based on a review of prior literature regarding social accountability 16 and other relevant citations from that literature, [1][2][3][4][5][6][7][8][9][10][12][13][14][17][18][19] the research team developed a draft interview guide to address our study aims. Specifically, we sought to examine definitions of social accountability in GME, as well as suggestions for, perceived value in, and barriers to measurement.…”

Section: Question Development and Pilot Testingmentioning

confidence: 99%

“…[8][9][10][11] The Medicare Payment Advisory Committee (MedPAC) has gone further, recommending the creation of an advisory body to develop performance measures and increased accountability linked to GME payment. 12,13 The Patient Protection and Affordable Care Act gave related responsibility to COGME to ''develop, publish, and implement performance measures; develop and publish guidelines for longitudinal evaluations; and recommend appropriation levels'' for GME programs based on an accountability framework.…”

Section: Introductionmentioning

confidence: 99%

Toward Defining and Measuring Social Accountability in Graduate Medical Education: A Stakeholder Study

Reddy¹,

Lazreg²,

Phillips³

et al. 2013

Journal of Graduate Medical Education

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Background Since 1965, Medicare has publically financed graduate medical education (GME) in the United States. Given public financing, various advisory groups have argued that GME should be more socially accountable. Several efforts are underway to develop accountability measures for GME that could be tied to Medicare payments, but it is not clear how to measure or even define social accountability. Objective We explored how GME stakeholders perceive, define, and measure social accountability. Methods Through purposive and snowball sampling, we completed semistructured interviews with 18 GME stakeholders from GME training sites, government agencies, and health care organizations. We analyzed interview field notes and audiorecordings using a flexible, iterative, qualitative group process to identify themes. Results Three themes emerged in regards to defining social accountability: (1) creating a diverse physician workforce to address regional needs and primary care and specialty shortages; (2) ensuring quality in training and care to best serve patients; and (3) providing service to surrounding communities and the general public. All but 1 stakeholder believed GME institutions have a responsibility to be socially accountable. Reported barriers to achieving social accountability included training time constraints, financial limitations, and institutional resistance. Suggestions for measuring social accountability included reviewing graduates' specialties and practice locations, evaluating curricular content, and reviewing program services to surrounding communities. Conclusions Most stakeholders endorsed the concept of social accountability in GME, suggesting definitions and possible measures that could inform policy makers calls for increased accountability despite recognized barriers.

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“…1 Accordingly, in 2010 the Medicare Payment Advisory Commission (MedPAC) proposed to reallocate over one-third of the current $9.5 billion of Medicare funding towards GME as performance-based payments, rewarding residency programs that educate physicians on the basis of the following: integration of community-based care with inpatient care, practice-based learning and improvement, and systems-based practice. 1,2 In addition, it has recently been proposed that providing high-value, costconscious care become a new core competency for training physicians. 3 Such proposals skip a key step: residency programs currently lack a clear strategy to prepare residents to assess and deliver value-based care.…”

Section: Introductionmentioning

confidence: 99%

The VALUE Framework: Training Residents to Provide Value-Based Care for their Patients

2012

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National efforts to improve the value of health care must include graduate medical education (GME) if they are to succeed. Proposals to teach residents to provide valuebased care have come from the Medicare Payment Advisory Commission (MedPAC), the Accreditation Council for Graduate Medical Education (ACGME) and the American College of Physicians (ACP). Such proposals skip a key step: residency programs currently lack a clear strategy to prepare residents to assess and deliver value-based care. In this article, we present the VALUE Framework for programs to utilize to teach residents to assess and deliver value-based care for their patients. We then present more than 20 opportunities for residency programs to incorporate training in value-based care.KEY WORDS: medical education; residency training; graduate medical education; value; health care value; value-based care.

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Transforming Graduate Medical Education to Improve Health Care Value

Cited by 58 publications

References 2 publications

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Toward Defining and Measuring Social Accountability in Graduate Medical Education: A Stakeholder Study

The VALUE Framework: Training Residents to Provide Value-Based Care for their Patients

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