Filak Discusses Changing Environment, Tools in Medical Education
Two terms dominated the discussion of education at the College of Medicine Tuesday, March 11, 2014: "teams” and "change.”
In "Working Together to Advance Medical Education,” Senior Associate Dean for Academic Affairs Andrew Filak Jr., MD, gave an overview of changes in graduate medical education accreditation and proposed funding, undergraduate and international programs at the college and how, working as teams, college faculty and staff are collaborating to meet the challenges of changing times.
Changes in GME On any day this year, over 630 residents are training and working across the UC Medical Center and College of Medicine campus. With 94 residency programs, UC trains a broad range of general and specialist medical professions—but we need to work on the diversity of the residents themselves, says Filak.
In the college’s office of diversity and inclusion, Associate Dean Mia Mallory, MD, and Assistant Dean Chris Lewis, MD, have been working with program directors and interviewing residents in an effort to diversify our trainee population.
Nationally, accreditation bodies are changing how they evaluate residency programs. Instead of the historical five-year accreditation cycle, the ACGME is switching to a model of continuous monitoring with site visits as needed and a regular 10-year review.
The ACGME’s Next Accreditation System, (NAS) shifts the responsibility for monitoring back to each institution, says Filak, requiring the college to submit program data each year.
In the next few months, ACGME reviewers will visit campus to focus on the safety of the environment and quality of patient care at UC Medical Center as part of the Clinical Learning Environment Review (CLER) program.
Changes are also on the horizon for the funding of GME through the federal government and state Medicare and Medicaid offices. At the national level, the recent budget proposal submitted by President Barack Obama decreases Medicare’s Indirect Medical Education (IME) payments to residency programs by 10n percent—which would mean a $3 million loss for UC Medical Center. At the state, there are talks of shifting money to support other training or health care areas.
Filak stated that the potential loss in funding "impacts our ability to create new programs and impacts the ability to increase the size of our programs.”
Successful Innovations Filak also highlighted two UC-developed programs as key examples of teamwork to meet changes in medical education.
In the department of internal medicine, a team led by Eric Warm, MD, has created a program to measure resident progress through standardized milestones utilizing observable practice activities. A description of the system has been accepted for publication in the Journal of General Internal Medicine.
"With their concept of entrustable assessment, this team is a national leader in internal medicine and in graduate medical education,” says Filak. "With their program, you have real-time data to assess where each resident is, so educators can help them move forward in the program.”
This July, Amy Bunger, PhD, and Paul Wojciechowski, MD, will measure residents from day one of their training, with their Baseline Residency Assessment of Clinical Knowledge (BRACK) program. Bunger, assistant designated institutional official and co-principal investigator of BRACK, first piloted the program with co-PI Wojciechowski, assistant professor of anesthesia, in 2011.
BRACK uses clinical supervisors and the college’s Sim Center to test the incoming residents in a variety of clinical situations and diagnoses before they begin training.
"It’s a big undertaking,” says Filak "to answer the question, ‘Are our entering residents prepared to take call on the first day?’ ”
Undergraduate and International Education Change is also coming through new programs, says Filak, both based at the college and internationally.
After drafting a white paper in June 2012 on undergraduate medical education, professor of molecular genetics Anil Menon, PhD, created a Minor in Medical Sciences that has enrolled 32 students in its first year and is enrolling students for the program’s second year.
A plan for a College of Medicine-based bachelor’s degree in medical sciences is under review at UC prior to submission to the Ohio Board of Regents for approval.
"It’s a student-centered approach to undergraduate education, with teams of educators that build up to offer a tremendous product for the students,” says Filak. "It’s a highly competitive program—and an impressive feat to put that program together in that short a time.”
Internationally, a team of Academic Health Center leadership recently returned from a trip to China, where they worked with Chongqing Medical University to further existing plans for an International College of Medical Sciences, taught by UC faculty.
The program would include undergraduate, graduate and doctoral level classes in medicine, nursing and pharmacy. Filak said the team is is working on a model in which UC faculty can travel to China to teach intensive, month-long courses.
They expect to submit a final proposal to the Chinese Ministry of Education in the near future—with an earliest possible start date of 2015.
Working in teams in the college, the university and across the globe, Filak says the college needs to keep its focus on the challenges ahead: "The practice of medicine is changing,” he concluded. "We need to make sure we are changing—and that our students are learning what they need to know to practice in the future.”