“We must be role models for the rest of our population and we must be role models for those who follow us and those we educate and, I would posit to you that compassion is the amplifier that will make it all happen.”
An inspiring quote from ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP as he addressed the virtual crowd of approximately 6,000 in his President’s Plenary, kicking off the ACGME Annual Educational Conference on Thursday, February 25, 2021.
Dr. Nasca shared evidence, actions, and personal perspective on the ACGME’s journey of mastery as an accreditor, the new ACGME strategic plan, and what he called the three concurrent pandemics: COVID-19; the “parallel pandemic” of clinician well-being; and the “moral vacuum” and inequity in society.
Dr. Nasca described the third pandemic as encompassing the 5 Is:
Perhaps most powerful, given the challenges of the last year across the nation, was the acknowledgement of the need to fight the 5 Is. While thanking the profession for having demonstrated monumental altruism, competence, and compassion throughout COVID-19, Dr. Nasca urged medical educators to serve as role models and pave the way for a brighter, more equitable future for all.
Journey of Mastery
Before turning to the circumstances of today, Dr. Nasca shared pivotal moments in the ACGME’s progression as an accreditor.
He began the historical account in 1998 with a discussion of the Outcomes Project, which focused on the development of general competencies for residents/fellows, as well as the outcomes of those processes. He highlighted the impact of clinical work hours (formerly duty hours) and the establishment of the first congress to convene the medical community around the issue. He spoke of the ACGME’s Next Accreditation System, including data-driven annual reviews of institutions and programs, formation of the Clinical Learning Environment Review (CLER) Program, and the commitment to patient safety, quality, and elimination of disparities.
Dr. Nasca also spoke of key learnings over the last 40 years, among them the persistent need to strike a balance between education and outcomes and the importance of the ACGME Milestones in competency-based medical assessment.
“The Holy Grail of outcomes is the effectiveness of our graduates in clinical practice,” he said.
ACGME Strategic Plan and Stress Test
“We wanted to anticipate the future and educate for the future rather than react to the future.”
Next, Dr. Nasca updated the community on the ACGME’s new Strategic Plan, Mission, Vision and Values.
Building upon the ACGME’s journey toward mastery, he described perspectives gained through a futures scenario planning process: the importance of outcomes today and within the first seven years of physician practice; GME as the pivotal phase in the continuum for cost, quality, safety, and equity; and the need to plan for exogenous risks.
The new strategic plan connects the dots in moving from circumstantial education to intentional, competency-based education. It includes two new strategic direction statements around professionalism and ethics and enhancing the clinical learning environment. The updated vision looks to the Quadruple Aim, and the values of diversity and inclusion sit alongside equity and fairness to be woven into the fabric of everything the ACGME does. Pivotal investments in technology and research are among those prioritized to prepare physicians for the future of health care delivery.
Dr. Nasca said the strategic plan is durable and anticipatory of many of the vulnerabilities faced today, including the COVID-19 pandemic. However, he emphasized the need for strong support and oversight across the continuum for medical education to be successful.
“Potential complacency or inaction, or an unwillingness to act by medical education and its oversight stakeholders will be dangerous, especially because the US medical education system is a single-point-of-failure system,” he said. “It is a complicated, well-oiled system that works well in a steady state, but interruption of any one element threatens the viability of the entire function.”
Call to Action
As Dr. Nasca focused on the current landscape, he spoke directly to the profession with a strong call to action. Referencing the Hippocratic tradition and oath, he emphasized that medicine is a social good, noting that physicians are crucial in making decisions about the just distribution of health care to maintain the well-being of society. Of utmost importance, he stated, is building trust with patients.
“Trustworthiness on the part of the observer, the receiver, who establishes the trust, varies based on our demonstrated compassion and our sympathetic consciousness of others’ distress together with our desire to alleviate it,” he said.
Dr. Nasca closed his talk with provocative questions around the medical profession’s role and the value of human life. He urged listeners to leverage the trust earned during the COVID-19 pandemic to help society fight the pandemic of the 5 Is.
“We must, in all our actions, live the values that we espouse and be exemplars of the profession-in-action.” He spoke of the challenge of our time: to achieve the Quadruple Aim, end racism and intolerance in society, and attain equity for future generations.
“We can, and we must,” he said, “use our gifts for the betterment of our fellow human beings. We must start with those around us and leave no one behind. We must be role models for those who follow us.”