UNMC News

Resident and fellow training programs implementing new system

Marks biggest change in medical education in more than 100 years

Marks biggest change in medical education in more than 100 years

It’s touted to possibly be the biggest change in medical education in more than 100 years.

It’s called the Next Accreditation System, and it will totally change how resident physicians and fellows are trained.

It goes into effect across the country in July 2013 with seven specialties – internal medicine, pediatrics, emergency medicine, neurosurgery, radiology, urology and orthopaedic surgery – being the first to implement the system.

By July 2014, all 23 medical specialties and their fellowships will have to implement the NAS.

“This is a well overdue paradigm shift,” said Kelly Caverzagie, M.D., assistant professor, internal medicine, for the University of Nebraska Medical Center. Dr. Caverzagie is a member of UNMC’s Graduate Medical Education Committee, which is working closely with the UNMC Center for Continuing Education to implement the system.

“This marks one of the most significant changes in medical education since the Flexner Report came out in 1910,” said Michael Wadman, M.D., associate professor and vice chairman of emergency medicine and assistant dean for graduate medical education.

With NAS, residents will be evaluated to see if they have achieved important educational outcomes called Milestones over the course of their training. The outcomes will continue to be categorized by six different general competencies:

  • Patient care;
  • Medical knowledge;
  • Interpersonal and communication skills;
  • Professionalism;
  • Practice-based learning and improvement; and
  • System-based practice.

“Right now, our system for evaluating residents is heavily weighted towards process and structure,” Dr. Wadman said. “It’s based on a resident accomplishing or completing certain tasks.”

Dr. Caverzagie said the new system will take away the subjectivity of evaluating residents. “It will define the outcomes that we expect our residents to accomplish,” he said. “It gives them the direction they need to move forward.  It is a very meaningful change that really makes sense.”

He said the new system is being introduced because there is evidence that residency programs are training physicians who are not ready to function in our increasingly complex health care system.

Residents will need to achieve these Milestones that will be spelled out to them over the course of their training, Dr. Caverzagie said.

“It no longer will be good enough to be the top resident in your class,” Dr. Caverzagie said, “because that could mean that you are merely the best of an incompetent group.

“I believe the new system will help those who are lower performers, because it will let them know exactly where they need to be, and it will help high performers by challenging them to continue to improve.”

Each residency program will be responsible for providing semiannual reports to the Accreditation Council for Graduate Medical Education on the progress of their residents.

In addition, every 18 months, a Clinical Learning Environment Review will be conducted by the ACGME. The CLER visit will determine if residents are working in a positive and healthy learning environment and will help ensure quality improvement and patient safety.

Most residencies last from three to five years, but some last as long as seven years. UNMC has approximately 495 resident physicians in 42 different programs.

For more information on NAS, visit http://www.acgme-nas.org/index.html.

Through world-class research and patient care, UNMC generates breakthroughs that make life better for people throughout Nebraska and beyond. Its education programs train more health professionals than any other institution in the state. Learn more at unmc.edu.

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Tom O'Connor
UNMC Public Relations
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