Blockbuster report could revolutionize medical education

The pressure on medical students to secure a place in residency is immense, leading many of them to engage with dozens of programs, often at great expense. The process emphasizes leading with one’s strengths rather than understanding where a student needs to grow and which residency program is really the best “match” to becoming the best doctor possible, according to a national report from the. Undergraduate Medical Education – Graduate Medical Education Review Committee (UGRC), convened by the Coalition for Physician Accountability. (OHSU)

Each year as March rolls around in medical schools and residency programs across the country, the pressure mounts.

For fourth-year medical students, the question is, will I land a place of residence – preferably one that I want – or will I derail after everything I’ve done?

For medical programs, it’s: Will all of our students get slots – the 100% sought-after correspondence that makes headlines in college newspapers, admissions brochures, and annual reports?

For residency programs, it’s the same: are we going to fill all of our niches, meet the demands of our workforce, and protect our national reputation as sought-after programs?

Head of George Mejicano, MD, MS

George Mejicano, MD, MS

For George Mejicano, MD, MS, Senior Associate Dean for Education at OHSU School of Medicine, these responses are emblematic of an uncalibrated system to produce the doctors society needs most – doctors, as Mejicano explains, who “intend to reduce disparities, improve health outcomes and make our world a fairer place.

“Essentially what we have right now is an inconsistent system, and there are competing agendas such as what is best for a given stakeholder group will trump what might be best for the company,” Mejicano said. “Medical students lead with their strengths, burying their weaknesses and applying to a series of programs – which costs time and money – for fear of not getting a place. It’s a pressure reinforced at every step by their medical school, residency programs, and other stakeholders that prioritize trust over humility and introspection.

House of Medicine looks inside

This is only an outline of the conclusions of a blockbuster report published in late August by the National Undergraduate Medical Education and Medical Education Review Committee (UGRC), which Mejicano co-chaired.

The committee was created by the Coalition for Physician Accountability, which is made up of what is collectively known as the House of Medicine – the same stakeholders have called for reform. They include: all relevant accreditation bodies, from the Liaison Committee on Medical Education (LCME) to the Accreditation Committee on Higher Medical Education (ACGME); the American Medical Association and the American Osteopathic Association; the National Residence Matching Program (which organizes “Match Day”); the Federation of State Medical Commissions (the regulators); and the National Board of Medical Examiners (the writers of standardized tests).

The report, “Recommendations for an Overall Improved UME-GME Transition,” includes 34 guidelines organized around nine themes: from collaboration and continuous improvement and from diversity, equity and inclusion to fair review of applications and optimization of applications, interviews and selection. Process. The northern stars of the committee, said Mejicano: the public good and the defense of diversity, equity and inclusion.

“This report has the potential to revolutionize medical education in America,” Mejicano said. “The big question is whether the recommendations as a whole will be effectively implemented across the country. “

Break the box

The committee’s work grew out of a national conversation that began in 2018 on the use of digital scores associated with medical licensing exams in the screening and selection of residency applicants.

A review resulted in recommendations regarding the negative impact of overemphasizing these scores and the racial and demographic biases embedded in the tests. As a result, Stage 1 of the United States Medical License Examination Series (USMLE) will eliminate digital score reporting across the country in January 2022.

The Medical College Admission Test (MCAT) is the subject of a similar exam. “The pulse” of national public radio featured experience in March from Mollie Marr, a medical school student at OHSU, who had to take the MCAT four times before being admitted. She has now obtained her doctorate. in Behavioral Neuroscience and completed the MD part of his MD / Ph.D.

Mejicano co-wrote a Letter to the Editor-in-Chief of Academic Medicine noting that medical schools with the highest average MCAT scores have moderate levels of student body diversity “assessing the cost of maintaining stature in American News and World Report rankings on diversity, equity and inclusion.

He and his colleagues at OHSU School of Medicine, Tracy Bumsted, MD, MPH, Associate Dean for Undergraduate Medical Education, and Rob Cloutier, MD, MCR, Associate Dean for Admissions at UME, are calling for the MCAT to succeed / fail to “leave the door open for more multidimensional discussions about what our candidates offer to the profession and to future patients without sacrificing quality.”

Transition from medical school to residency becomes the target

Such discussions led to a greater focus on reforming the inherent and pervasive challenges associated with the transition from medical school to residency and UGRC committee formation. The 30 members of the group included everyone from members of the public to medical students, clerkship directors, leaders of professional societies and members of organized medical stakeholder groups.

Additional recommendations focus on areas such as:

  • Require training on anti-racism and diversity, equity and inclusion for all members of the medical education community to avoid perpetuating abuse
  • Make the residency interview process fairer
  • Better preparation of medical students for residency
  • Putting an end to “arms race” residency applications

As the AAMC article on the report notes:

“Fearing not to gain space, applicants for residency are submitting more and more applications. Between 2016 and 2020, the average number of applications submitted by candidates increased by more than 8% from 87.7 to 95. Graduates of international medical schools, who often face additional obstacles in finding a residency position, have reached on average 136 submissions.

“This year, we received 5,800 applications for 24 positions. Most of them just can’t be looked at in depth, ”said Richard Alweis, MD, UGRC committee member and deputy chief medical officer for medical education at Rochester Regional Health in New York City.

Applicants could apply to fewer programs if they had a better understanding of where they had a chance of being accepted and if programs seeking to sort their candidate pools had better information, suggests the UGRC.

A path of transformation?

Taken together, said Elise Lovell, MD, UGRC co-chair and director of the emergency medicine residency program at Advocate Christ Medical Center in Oak Lawn, Illinois, the recommendations are “transformational.”

Committee member Grant Lin, MD, Ph.D., a pediatric resident at Stanford Health Care in California and a committee member, agreed.

“For the past 10 years or more, we’ve been stuck in one place,” he said. “The recommendations are a monumental step in breaking through this. “

The UGRC forwarded its recommendations to the Coalition for Physician Accountability for review and implementation. As Mejicano notes, there are some of the recommendations to be implemented within the scope of individual schools – such as the work of the OHSU to analyze the clerkship scoring for bias and decision to stick to virtual residency program interviews for the next admission cycle, as it levels the playing field in terms of time and cost to fly to multiple sites.

But he said that to fully implement the recommendations at all levels, many organizations will need to work together and agree to the reforms. And that may require restructuring some organizations financial incentives, as they may have products and services that depend on the status quo.

But Mejicano witnessed the will during the hard-hitting committee work and is hoping there will be a way.

“Getting a group of people to put their personal agendas aside and come to a common understanding of what the country needs, what the society needs and what we need to do to get there has been incredibly rewarding for all of us, ”Mejicano said. “For the House of Medicine – all organized medicine – to say, ‘We have to solve this problem.’ Is a once in a generation opportunity.


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Bertha D. Parker

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