The Role of Graduate Medical Education in the New Health Care Paradigm

Recently HRSA released the 22nd report from the Council on Graduate Medical Education, titled; “The Role of Graduate Medical Education in the New Health Care Paradigm”

We’ll spend the next few weeks providing some highlights and commentary.

Challenges and Opportunities in Expanding GME Experience (p.17)

“Although the data on the impact of training sites on the quality of care provided by GME graduates is limited, there is a common misperception that only training in large academic centers can produce graduates who have the skills to provide high quality care. Asch and colleagues have found obstetrical outcomes are affected by training site, linking quality of training site with the outcomes of care provided by the trainees. However, other studies on this topic leave doubt about which markers should be used to evaluate physician practice quality in relation to residency training sites.

“In addition to concerns about quality of teaching and patient care in community and ambulatory settings, another barrier to expanding GME training to these sites is the lack of financial support for community-based programs. Present payment and training incentives for community-based training are insufficient to develop and maintain these ambulatory and community-based programs, even though it costs less to provide patient care and GME training in these sites, than AHCs and other teaching hospitals. The increased costs of AHCs and other teaching hospitals are in part due to their higher patient care costs. This includes the number of underinsured, biomedical research missions, and the maintenance of standby capacity for medically complex patients, in addition to the expenses incurred by teaching programs.”

For GMEC, this is key as training in Southwest Virginia offers the local, ambulatory, outpatient experience.  On page 23, the report states, people “expect the medical education system to produce physician specialists who reflect the cultural and economic characteristics of the patients they serve“.

With this expectation in mind – the medical education community needs to recognize that the only way to fully prepare a future physician to serve in rural Appalachia is to train that student in Appalachia.  Reviewing information about rural Southwest Virginia is not sufficient to produce a culturally competent doctor – immersion is required.