Knitting the Continuum Together: Seizing the Opportunity to Improve Medical Education

Published Date

Timothy P. Brigham, MDiv, PhD, Chief of Staff and Senior Vice-President, Accreditation Council for Graduate Medical Education (ACGME), and Kate Regnier, MA, MBA, ACCME Executive Vice President, reflect on strategic opportunities for medical education accreditors and hospital leaders to collaborate to improve health care safety and quality.


>>REGNIER: What could we work on together?

>>BRIGHAM: I think one of the things, one of the opportunities that we have here, at this place in time, you know, I talked a little bit earlier about where the space time continuum has torn a hole in the fabric of the Universe. And there’s this really neat

>>REGNIER: [laughs] such a great opportunity

>>BRIGHAM: it’s such a great opportunity is to really knit the continuum together. Nationally we’re siloed, UME, CME, GME And the institutions that I visit most of the time there’s this amazing silo of the CME people not knowing really what the GME people do and the GME people and the CME people tangentially knowing what’s going on in the undergraduate arena. I think we have a rare opportunity to do this on a national stage to knit the continuum together, to do the kinds of things that only our two organizations can do because of our resources and the kinds of aspirational pressures we can put on the field. But also, to have that be a model for what happens in an institution, you said it earlier, you know, one of the things that the CLER Visits will do will almost force in a really good way the QI and the patients safety people and then the organizations that talk with the CME people. And their going to be engaging with the designated institutional officials in GME. What a powerful, powerful group of people that would be, if we could get those, the patient safety and quality people with the GME people and with the CME people all doing the things that are within their realms but collaborating in a way that we have not seen before. Faculty development from the CME side, resident learning from the GME side, and you know, those boundaries mesh in a lot of ways.

>>REGNIER: And at the same time, making sure that the accreditation process and requirements support that kind of collaboration

>>BRIGHAM: Correct.

>>REGNIER: As opposed to, worst case scenario, pointing in different directions

>>BRIGHAM: Right.

>>REGNIER: Best case scenarios, the redundancies are eliminated. And


>>REGNIER: And what we require, what we look for in terms of documentation or compliance is just supportive of CME practice that supports what you’re talking about.

>>BRIGHAM: Yes. We’re, you know, in 2005 our Board came up with four strategic imperatives, which were like their dream. And those four strategic imperatives were, to create a accreditation system where we spark innovation not thwart it, that we reduce burden not increase it, that we move away from process, how many times did you do something, not that that’s unimportant in all areas, but can you do it at the end of the day and to increase communication with internal and external stakeholders. That’s what our next accreditation system is; those are the principles on which they’re based. And the philosophical principles underlying even those things came from that task force that renamed itself the Patient Safety and Quality Task Force. And those are three things that we can partner with in ways that I don’t think we’ve even imagined now, those three things are the safety and the quality of care of the patient under the care of the resident today; the safety of the patient and the quality of care of the patient under the resident when the resident is in practice. And the creation of a humanistic learning environment, where they can learn aspects of professionalism and effacement of self interest that will make them the kind of physicians that they want to be not just that we want to be. We can, we can meaning CME at the ACCME level and the AGME level and CME at the local level and GME at the local level I think can partner in those three areas and those four other areas that I just talked about in ways that we haven’t even dreamed of that are creative and innovative in and of themselves.

>>REGNIER: I like, I like your, your sort of description, knitting the continuum together, I would agree with you I think we have a real opportunity to do that. And I’m always struck about the fact that, you know, whether you consider them to be silos or this concept of sort of making it linear in, in fact, it’s really almost more circular. You know, because it’s not something you start with in UME and you end with in CME

>>BRIGHAM: Right

>>REGNIER: What happens in CME or in practice


>>REGNIER: Informs what’s going on in UME and GME


>>REGNIER: So, it’s really, in my mind, more about making this continuous

>>BRIGHAM: No, I look at it as organic. Where there should be, sort of, continual mixing. I mean the studies on creativity that they’ve done show that most creative moments are when you can get creative thoughtful intelligent dynamic people together in same room and they bump up or in the same place and they bump up against one another and those sparks those are the sparks of creativity that can take us to the next level.

>>REGNIER: Certainly, right.

>>BRIGHAM: When I was in CME, I was in CME and GME and I had that privilege, which was rare back when I first started, you were either in CME or you were in GME. Most of my colleagues back in the Nineties if they were in CME they were sometimes in a totally separate building from the GME folk and the UME folk. I think that’s changing and I think we can help drive that change.

>>REGNIER: Yeah I think hat’s changing too and I think, you know, we have an opportunity to sort of learn from the, like you described, sort of the innovative organizations institutions where they actually are now together. We have, we have quite a few accredited providers where the, the person in charge of CME is in charge of GME


>>REGNIER: And in fact, we also have a couple where they’re also in charge of QI.

>>BRIGHAM: Oh that’s really neat.

>>REGNIER: Where that comes together is incredible because that QI data those QI initiatives are informing everything they’re doing in CME and they’re integrating GME. I mean that’s you know it doesn’t get much better than that.

>>BRIGHAM: And I think one of the things we need to do as the two accrediting organizations is set ourselves up so that we do the things that I talked about with the four strategic imperatives. In other word that we don’t have the people who are running around in CME in GME just being mini compliance officers for accreditation standards. What we would like to do is have a rigorous accreditation model that guarantees, you know, that we will be graduating the kind of physicians for us that the public needs and deserves and wants. And that you’ll be having the kinds of physicians that will be educating and keeping up and moving to the practices of the future rather than keep doing what they learned in their residency program sometimes 30 years ago. We have to, our responsibility in some ways is to link up our accreditation, I think, in a way that gets us out of  the way a little bit, but still motivates in all kinds of ways the behaviors that we want. I went to a, I gave a talk at one of our major institutions in the country and we had a great, great, great time. We were talking and at one point somebody asked me a question and somebody else stood up in the audience stood up and said you can’t ask Tim that question. And I said, why? Well, because that would give the indication that we don’t know what we’re doing in terms of accreditation. The DIO’s office here is a, is a, is a, DIO designated institutional official and that office is a compliance office of the ACGME and all our program directors are compliance officers for the DIO’s office, mini compliance offices for the ACGME. And I said, That’s what you are? And they said, Yes. And I said, Well, that’s the problem. We don’t want mini-compliance officers, who are just spending 90 percent of their time wondering if they’re adhering to accreditation standards. We want the accreditation standards to be so much so exciting and enticing in some ways that what we want to do we want to create educational leaders.

>>REGNIER: Right, right.

>>BRIGHAM: Who take it to the next level. And if we can do that, if we can link ourselves up so that people can make sense of this accreditation model between the LCME and ACGME and the ACCME and including in the practice realm, maintenance of licensure and maintenance of communication I think we will have done a great thing a great service for, for the learners, for the faculty and various dimensions and ultimately and most importantly for the patients under the care of all of our learners. Whether they be in practice or all the way down to whether they’re first year medical student or before. That’s an important piece, I don’t even know if you want to put that piece in


>>REGNIER: No, I agree I agree

>>BRIGHAM: that’s sort of subversive

>>REGNIER: I would sort of comment on that by saying I agree. I think that we’ve had the opportunity here at the ACCME to be trying to promote accreditation requirements that are exactly like you describe. Reflective of the organizations doing effective, independent education.

>>BRIGHAM: Right.

>>REGNIER: Right. And what happens is the conversation usually terms around into documentation


>>REGNIER: What do we need to demonstrate compliance what documentation do we have to have? And, and we would benefit greatly I think from focusing our accreditation systems, both of us, on this approach and particularly for those organizations that are accredited by both of us and really decreasing the amount of work necessary but, but retaining the value.

>>BRIGHAM: Right.

>>REGNIER: I mean accreditation should be about value. Right?

>>BRIGHAM: Increasing the value.

>>REGNIER: Increasing, perfect. Perfect.

>>BRIGHAM: And one of the things I think that people should know is how hard we are working together right now to do that, to do that very thing. We’ve just come from a couple of meetings that are talking specifically about how we get the accreditors to work more fruitfully together. And you’ve been there and I’ve been there and the LCME has been there, the American Hospital Association has been there. I still think, maybe this is my final comment, I think we are in a rare moment in time where we can actually make a fundamental positive transformative change. And it’s up to us on the merry-go-round to take that brass ring and do something with it and I feel amazingly privileged to be working with you, to be working with the caliber of people I’ve been working with in the milestone groups, who are doing work way above and beyond the call of duty, Specifically because they believe so much in the education of young physicians and they want to do it, I love your thing, adding value to it not talking away. So, thank you.

>>REGNIER: Thank, you.




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