After a two-year hiatus from an in-person ACGME Annual Educational Conference and much uncertainty throughout the graduate medical education (GME) community, it was fitting that the 2023 conference closed with an interview with Thomas J. Nasca, MD, MACP, ACGME president and chief executive officer, on his views regarding the future of GME. Asking the questions was two-time ACGME Award recipient Debra Weinstein, MD, executive vice dean for Academic Affairs, professor, and chief academic officer at University of Michigan Medical School and Michigan Medicine.
Dr. Weinstein began by commenting on the success of the conference and its evolution over the years, asking about its future and where it goes next. Dr. Nasca said the ACGME does not think about the conference as an isolated entity, but rather the manifestation of a long-term goal to create the community of GME. He stressed, as did Timothy P. Brigham MDiv, MS, PhD, ACGME chief of staff and chief education officer, in his introduction of the session, that the ACGME’s primary function is as a convener of experts in GME. This was the theme of the session, as Dr. Nasca repeatedly referenced collaboration, trust, and innovation as a community.
Much of the session was geared toward GME faculty members, with Dr. Nasca noting that one goal of the ACGME is to minimize the burden and pressures on them to allow them to maximize their opportunity. When Dr. Weinstein asked about barriers to innovation, Dr. Nasca cited time for leadership to think about innovation. “I’m very concerned about the state of faculty [members],” he said. “We can’t escape the fact that we are hemorrhaging nurses and other caregivers and we are certainly losing doctors.” He stressed the need to listen to and support faculty members, referencing the new Clinician Educator Milestones as one tool that has come from that work to help them improve as educators and provide a useful framework for how they think about their careers.
The loss of physicians is why leaning on community and making incremental progress is so important, and it is also why data was a key part of the conversation. Dr. Weinstein asked Dr. Nasca if a single GME data structure could be expected in our lifetime. Dr. Nasca noted that the landscape is changing from local data centers to shared cloud functioning, but acknowledged the challenges that come with the current status of siloed educators. As joint progress is made on sharing data, he said, it is important to think about the types of quality parameters that are needed and what outcomes we seek.
The tightening physician pipeline, as medical school positions have outpaced GME ones, is a serious issue and Dr. Nasca acknowledged the GME pipeline is hard to expand. Progress in this area depends on specialties, faculty members, and research efforts. “Clinicians can’t be taught in the classroom, they are taught at the bedside,” he said. He made clear that while the ACGME is limited in affecting the pipeline into medical school, it has made strides to increase opportunities for residents and fellows, such as the Rural Track Program designation. He stressed his view that it is important that “everyone who is capable of having a residency program, have a residency program.”
Dr. Nasca also discussed the progress made through the work of ACGME Equity MattersTM and the ACGME’s Department of Diversity, Equity, and Inclusion. He asserted that to make progress in diversifying the pipeline of learners, “the most important thing we can do is diversify the faculty.” He stressed that diversity, equity, and inclusion (DEI) are not goals, but rather values, and stated that “we need to live DEI in everything we do. It’s not some category on the side, it’s about all of us in the same vector. It’s about the hearts and minds of people welcoming everyone under the tent.”
The session ended with optimism as Dr. Nasca motioned to the thousands in attendance, saying that what gives him hope begins with everyone in the room. “We have to be eyes wide open when tackling the obstacles of the future,” he closed.