Wednesday, February 22, 2012

The ACGME's Updated Accreditation System for GME

So the ACGME today just announced a major restructuring to the process of how residency and fellowship training programs are reviewed.    It is called the NAS (Next Accreditation System).  Take home points  from the article, published today online in the New England Journal of Medicine:
1.      Measurement and reporting of outcomes occur through the milestones  (this “grounds the competencies and makes them meaningful”)
2.      Programs submit milestone data on residents every 6 months.
3.      Sponsoring institutions will be responsible for the quality and safety of the environment for learning and patient care.
4.      Programs can be formally reviewed with a “site visit” every 10 years (this is VERY similar to the ACCME, which accredits CME programs, with the “self-study” process).
5.      The accreditation system focuses less on problem identification and more on success of programs in addressing them (this is quality improvement in its purest form, in my opinion).
My personal opinion: I am VERY glad that the ACGME mentioned self-regulation in the article.  If the medical education profession did not regulate itself, then others who likely have no business evaluating medical education would be regulating it.  Kudos to the ACGME, for listening to program directors that the administrative “burden” was overshadowing the education of trainees, which I feel is the reason most program directors chose to do what they do.
I believe that it is wonderful that the ACGME took on this ambitious NAS endeavor.  I look forward to what the next steps will be.  What are your thoughts?

Sunday, February 19, 2012

What Is Med-Peds?

Most people understand the specialty of pediatrics: the care of children.  The advocacy group for pediatricians is the AAP, or the American Academy of Pediatrics.  Fewer understand the specialty of internal medicine (“medicine” for short), which is the care of adults.  The specialty society for this group is called the ACP, or American College of Physicians.
I am both of these.  I am both a pediatrician AND an internal medicine doctor (called an “internist”).  The name of the “specialty” given to what I do is called “Med-Peds”.
Med-Peds training is relatively unique, in that it incorporates half of its time (2 years) in internal medicine and the other half (2 years) in pediatrics.  After this training, doctors are eligible to go into practice in internal medicine, OR in pediatrics, OR in both (this last is ideal).  They can also choose more subspecialty training in internal medicine, OR in pediatrics, OR in both.  This flexibility in career options is quite attractive to those who choose our field.
Med-Peds is considered a primary care field.  Obviously, family medicine is a primary care field, as is pediatrics and internal medicine.  But in all of these options, trainees can choose further training.  This article (focus on Table 1) highlights the percentages of each which go into primary care.  Many forget that Med-Peds is a great option for those interested in primary care.  Others consider Med-Peds a great choice for those in medical school who can’t decide what they want to do.  Whether one chooses Med-Peds for any of these options is not critical: they chose it for their own reason, and that is what matters most.
What I have the privilege of doing within Med-Peds is being an educator.  At Indiana University School of Medicine, I oversee a Med-Peds residency program (the largest one in the country), and love the opportunity to train future physicians, no matter what their interests.  Niches within Med-Peds include transitional care (caring for patients as they transition from being a child to being an adult) and global health.  However, it is important to realize that Med-Peds alone as a specialty cannot be solely responsible for transitioning every child with a chronic condition to adulthood, and that other physicians need to be comfortable in thinking about this transition.  One of my Indiana University colleagues and mentors, Dr. Mary Ciccarelli, was involved in writing a document about transitional care, which was recently published, and has been passionate about furthering the concept of transitional care.
Explaining Med-Peds to physicians not familiar with it is difficult enough explaining it to patients is even harder (hence the reason for this post).  Med-Peds is not necessarily an “alternative” to family medicine (for the record, I do not “bash” family medicine as a specialty); the training is very different, yet many in both end up practicing similarly, in a primary care arena.
If you are a medical student, I encourage you to think about Med-Peds as a specialty.  If you are a patient, I encourage you to consider a Med-Peds doctor as your primary care physician.  Here are some quick facts about Med-Peds:
The training is four years total: two in pediatrics and two in internal medicine.
The training allows opportunity to pursue further training in either pediatrics, or internal medicine, or both.
A wonderful organization which promotes Med-Peds is called NMPRA (National Med-Peds Residents’ Association).  This website provides the best explanation of Med-Peds that I have seen.
A wonderful organization which promotes the education of Med-Peds trainees is called MPPDA (Medicine-Pediatrics Program Directors’ Association).  I was honored to serve as the president of this organization from 2010-2011.
Med-Peds is the only “combined” residency which is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
There are currently 77 residency programs in Med-Peds accepting residents in the National Residency Match Program (the “Match”).  We would like to see Med-Peds grow as a field and have more accredited programs.
A blogger who has the same Med-Peds training as myself (and completed his training just as I was beginning mine at Indiana) is Dr. Rob Lamberts.  Here is his current website.
The Med-Peds Section of the American Academy of Pediatrics is the second largest section in the entire Academy.
I would love to hear your comments about the field of Med-Peds.  It is a wonderful specialty, and I am honored to call myself a Med-Peds doctor!

Thursday, February 16, 2012

Social Media in Academic Medicine

The inspiration for this post came from a Twitter chat on the theme of Social Media in Academic Medicine on the “meded” chat, on Thursday 2-16-2012

Social media is definitely integrated into today’s culture. So many young people are using social media. In addition, a quicly growing demographic in social media is actually those in their 40s-50s. Despite this impressive growth, social media has not, in my opinion, made its way into mainstream academic medicine yet. Certainly papers have been written on the topic of social media in medical schools, but much of the focus has been on professionalism around using social media, and less on what positives social media can bring to medicine.

With regards to social media in academia, however, the growth is slow. Promotion of faculty in academia on the strength of a portfolio focusing on social media is currently probably not that common. But should it become more common in the future? Will physicians who choose to be engaged in social media for purposes of promoting medical education or medicine consider this as their main “scholarship”? And what about the physician who chooses to blog on medical topics (which can provide quality information on the internet to counteract some questionable medical material that currently exists)? Is that something to put on a dossier? Surely it can attract an audience, and can provide useful information to patients and those interested in health.

Finally, as we talk about the hidden curriculum in medicine often, how should the academic physician who is “laughed at” or “taunted” for tweeting or blogging react when she hears: “You are wasting your time with that social media stuff.” (you can probably ascertain that indeed I have heard this quote more than once)

I have my opinions, and would love to hear yours. I will leave you with a few articles on Social Media in the academic arena.

Professors like social media more than other educational technology

How higher education uses social media

Social Media Footprint for Academics

A doctor's reputation vs a hospital's responsibility: Social Media

Saturday, February 11, 2012

Quality Improvement in Medicine and Medical Education

There are fads in medicine (e.g., “Vitamin E can prevent heart disease”, which we now know to NOT be the case), and then there are things that here to stay. The movement of quality improvement (QI) is definitely in the latter category. The importance of quality improvement in medicine cannot be overemphasized, yet there are some who question the utility of QI. There are others who have bought into why quality improvement is critical towards improving patient care. A new arena within medicine of “implementation science”, where putting guidelines into actual practice constitutes success, is emerging. This has even transcended maintenance of certification. Part 4 of the process involves doing a specific quality improvement project aimed at improving one’s performance with regards to patient care. All of the medical specialties in the ABMS have such a requirement. Quality improvement is also embedded into the CME world as well, with Performance Improvement CME, or PI-CME, coming of age as an important aspect of what physicians do. So how does a clinician go about doing quality improvement? My suggestion is to think about something that doesn’t go as smoothly as one would like (in the CME world, this is known as a “practice gap”, which drives why it is important for physicians to continually be educated). Whether it be ordering necessary tests in diabetic patients (e.g., urine for microalbumin, LDL cholesterol levels) or improving throughput in the office, quality improvement principles can guide an approach toward improving “something” (whatever the something may be). Within medical education, quality improvement curricula are now no longer innovative: they are REQUIRED. Residency programs are required to teach quality improvement to trainees, although the ideal way to teach it is not known. The literature in this arena is clearly growing, however, which is exciting, and it is common now at academic medical centers for residents to provide excellent ideas for improvement projects. So why is there push back to looking at improving how one practices? In other words, what can the organizations which lead the QI movement do to achieve front-line clinician buy-in to the importance of the science of improvement? After all, the ultimate outcome is improved patient care outcomes, and who would not support that?