By Susan Kirk
Think of things a typical office of Graduate Medical Education (GME) does. Chances are a lengthy list of activities comes to mind: monitoring duty hours, distributing meal tickets, reviewing ACGME requirements, overseeing license applications, approving “moonlighting,” and wrangling over funding. However, developing faculty so that they are better equipped to teach, mentor, and develop our GME trainees (residents and fellows) is usually not considered the domain of the GME office. That’s unfortunate, because it is often the GME Office that serves as the center for faculty development on many issues critical to successful training programs.
In a recent survey on faculty development by the AAMC Group on Resident Affairs, 81 percent of respondents stated that least some faculty development is provided by the GME office at their institution. The GME office is well-positioned to provide essential information so faculty can educate and supervise residents effectively, and is often the place where program directors first turn for help when facing challenges within their programs. As we face significant changes to the evaluation of our trainees, the accreditation of our programs, and the role of GME in quality and patient safety at our institutions, now is the time for us to formalize the faculty development programs within GME and bolster the support of our efforts.
The Accreditation Council for Graduate Medical Education (ACGME) has explicit expectations that institutions both provide and oversee the development of faculty involved with GME trainees. In a few instances, there are specific professionalism requirements that faculty receive education, especially in the areas of fitness for duty, fatigue mitigation, recognition of impairment, time management, honest and accurate reporting of duty hours, and the provision of patient- and family-centered care. It is the “professionalism” competency where the ACGME most strongly voices its expectations: “Faculty development is critically important for promoting professionalism behavior because of past assumptions that since all physicians are professional, professionalism does not need to be discussed, taught, or evaluated.”
Other than stating in the program requirements that “faculty development must go beyond attendance at the occasional formal lecture,” and “faculty development should be monitored and recorded,” GME offices have not been given metrics to gauge their effectiveness in this area. However, their ability to effectively evaluate their success will be especially critical if the next accreditation System and Milestone evaluations are to be successfully implemented. While the ACGME realizes that faculty development for these changes must be “sensitive to time and financial constraints for many faculty members,” clearly, the devil is in the details that remain unknown. Moreover, there is a sizeable gap in providing faculty education in some of the most critical areas of our trainee work, such as providing effective career counseling. Likewise, who other than the program director and some of the key faculty really understand the new duty hour requirements? Do faculty know how to approach and where to refer a struggling resident? These are the types of issues that are discussed ad hoc, and often one-on-one, within the walls of the GME office.
Even the federal funding of Graduate Medical Education remains a mystery to most of the faculty involved with residents and fellows. An institution would ultimately be better served if its entire faculty understood the costs of GME and impending funding threats. An Internet search of some of the top AMCs and medical schools reveals that their offices of faculty development focus almost entirely on several areas: promotion and tenure, undergraduate medical education, work–life balance, and grant writing. Very few mention GME at all. As the Group on Resident Affairs respondents know, it is the GME office that is expected to fill the training education gaps.
How, then, do those in GME tether the time, effort, and resources to enact successful faculty development at their institutions? First, and most important, is to obtain recognition from senior leadership that the development of faculty involved in GME is essential for providing excellent and safe patient care. As noted by the ACGME for professionalism, we can’t just assume that all physicians, just by virtue of being physicians, can adequately teach, supervise, or evaluate. Additionally, with the constraints on today’s teaching faculty, there must be some recognition for faculty who devote themselves to training young physicians, either in the form of promotion and tenure or in a system that utilizes teaching relative value units (RVUs). Finally, this is a challenging time to enact new programs. Therefore, medical educators and GME leaders throughout the country should regularly share their insights, successes, and failures in GME faculty development programming so that limited resources are not wasted. In doing so, we ensure not only the success of our faculty, but the many trainees who depend on them for their own career successes.
— Susan E. Kirk, MD, is the Designated Institutional Official and Associate Dean for GME at the University of Virginia. She is an Associate Professor in Endocrinology and Obstetrics and Gynecology. Her clinical interests are in Type 1 diabetes and high-risk pregnancy. She can be reached at email@example.com.