AMA’s Moving Medicine video collection amplifies doctor voices and highlights developments and achievements all through medication.
Kicking off 2022 with the AMA’s “Look Forward/Look Back” collection, AMA Chief Experience Officer Todd Unger talks with Kimberly Lomis, MD, AMA’s vice chairman of undergraduate medical education improvements, and John Andrews, MD, AMA’s vice chairman of graduate medical education improvements, to talk about the AMA’s vital work in medical education.
- Kimberly Lomis, MD, vice chairman, undergraduate medical education improvements, AMA
- John Andrews, MD, vice chairman, graduate medical education improvements, AMA
Unger: Hello, that is the American Medical Association’s Moving Medicine video and podcast. As we start a brand new yr, we thought we might take this chance to look again at AMA’s work over the previous yr in a number of key areas and in addition discover out what’s in retailer for 2022. Joining us as we speak for our Look Forward, Look Back collection are Dr. Kimberly Lomis, AMA’s vice chairman of undergraduate medical improvements in Chicago and Dr. John Andrews, AMA’s vice chairman of graduate medical education improvements in Chicago additionally. And we’ll be discussing the AMA’s vital work in medical education. I’m Todd Unger, AMA’s chief expertise officer in Chicago. Dr. Lomis, Dr. Andrews, it is nice to have you ever again. Boy, has this been a yr of disruptions for medical education? Let’s assume about 2021 versus 2020. Did we see the identical challenges, completely different challenges or did vaccines enable, a minimum of, some normalcy of return? Dr. Lomis, let’s begin with you, with medical scholar education.
Dr. Lomis: Sure, Todd, I feel everyone is experiencing some distortion of time in making an attempt to bear in mind the place 2020 ended and 2021 started however I feel one of many massive issues that we noticed in 2021 was the commencement of scholars who had been considerably disrupted of their scientific preparations. And clearly, colleges have been working laborious to keep their coaching and fill these gaps. And so one of many issues that we invested in early this yr was a pilot program to assist every particular person graduate assume about what they missed out on, as a course of their coaching, and the way they could construct that into their objectives as they began their internship. So we created a terrific device that allowed them to begin upfront, discussing this with their program administrators and we’re very hopeful that this may carry forth sooner or later to normalize this transition. Everybody has individualized wants and will promote fairness that every particular person, as they make that transition, can actually name out the issues they need most.
Unger: We have been hoping to do one other medical scholar commencement tribute. The solid of Scrubs was not obtainable this yr, so we’re glad that folk did get to graduate. When you assume about the tutorial yr thus far, or as we shut 2021, how would you evaluate it to the preliminary yr of the pandemic?
Dr. Lomis: Well, actually there’s nonetheless been disruption and I feel any of the scholars concerned would say that, in addition to the educators however a minimum of we have been higher ready, each the well being methods when it comes to the provision of protecting tools, in addition to the education packages and actually considering about what roles college students can play safely. Plenty of these protocols round COVID care have been a bit of bit safer. And so, for essentially the most half, colleges have been in a position to get the scholars again on observe and hold issues shifting ahead. And truly, our consortium took a while to assume about the silver linings. What did we be taught in these disruptions that we might truly need to see carried ahead sooner or later? And there are some nice examples of issues we did be taught that we might do by simulation or distant and digital environments. One factor that we hope, because the AMA, will stick round is the elevated curiosity in utilizing telehealth. And we have created a playbook for educators about the way you convey these learners into that setting? So there’s some potential, some good options that we care about carrying ahead.
Unger: Yeah. Assuming we do transfer previous this pandemic in 2022, I feel that is a giant query for everybody is what we protect when it comes to these learnings and carry ahead versus forsaking. Dr. Andrews, let’s flip our consideration to residents and program directors. Again, how did this yr, 2021, evaluate to that first yr of the pandemic? What did we be taught?
Dr. Andrews: Well, the stress of the scientific response to COVID-19 is ongoing however not like 2020, I feel that, as Dr. Lomis alluded to, well being methods, hospitals have advanced methods for coping with COVID sufferers that weren’t in place when all the pieces exploded in 2020. And when that did occur in 2020, there was great concern about how the calls for of caring for sufferers with COVID was going to disrupt the trail towards education in your specific specialty, your path towards board certification as you turned your consideration to assembly the calls for of caring for sufferers with COVID, relatively than the stuff you thought you’d be doing.
I feel many residents have been apprehensive about that in 2020. I feel that is much less of a priority now. There’s nonetheless an amazing burden being positioned on our residents to present frontline care to sufferers with COVID however the methods for doing which might be much less disruptive to their progress in direction of certification within the specialty through which they’re coaching. So that is a bit of little bit of a constructive word to some. There’ve additionally been adjustments nationally, grace durations and alternate strategies for attaining board certification which have eliminated among the stress folks have felt that “If I’m doing all of this work to take care of sufferers with COVID, I won’t be eligible for certification in my specialty.” So I feel issues have calmed down a bit when it comes to these particular considerations about specialty coaching, whereas the calls for of caring for sufferers with COVID are ongoing.
Unger: Dr. Andrews, I know one of many issues that you have seemed deeply at is the residency utility course of. Big adjustments there, in fact, by necessity yr one, and continuation of numerous digital assist. What have you ever discovered over the previous yr? What do you assume among the main conclusions are going to be?
Dr. Andrews: Well, so the residency choice course of has been one thing that was fascinating earlier than the pandemic and is much more fascinating now. With the arrival of the pandemic, one factor that I feel everybody’s conscious of is that the method of making use of to residencies modified dramatically and that interviews turned digital. People weren’t visiting the establishments the place they thought they could practice. They have been conducting interviews just about. That created broad entry to alternatives to interview however much less deep data of the packages and the candidates for making that vital match to residency coaching later within the yr. And I feel the long-term results of that stay to be seen. Did folks match to packages that they won’t have in a state of affairs the place they really had an opportunity to go and go to? So we’ll see what occurs going ahead. I feel there was numerous constructive issues that got here out of digital interviews. It was much less of an administrative burden for packages. It was inexpensive and concerned much less journey for candidates. And in order a lot as folks need to get again to in-person interviews for the entire causes I simply said, I feel that choices to interview just about will proceed to be obtainable and can proceed to improve folks’s entry to packages that they won’t have in any other case been in a position to check out. So there have been some pluses and a few minuses to that.
The final thing I’ll say about the residency choice course of, and Dr. Lomis may need to remark additional, is I feel there is a graduating class of medical college students which have some considerations about the influence of COVID on their preparation for residency and whether or not there are gaps in that preparation which may need to be addressed in residency going ahead. And once more, we’re nonetheless studying about that and doing numerous work on the AMA to higher perceive these gaps and the way to greatest handle them.
Unger: Dr. Lomis, what do you assume about that?
Dr. Lomis: Well, that was a part of the pilot that I used to be mentioning earlier that we enacted as a result of there are actually gaps and I feel reframing it when it comes to gaps within the college students’ expertise is much less threatening to them as a person than saying that you just, particular person, have a deficit. And so we needed to seize on that second in time to say, “It’s okay. Let’s discuss about it. We know this occurred and the one means we are able to get by this and ensure your education is up to snuff and that the sufferers are served properly is to discover these gaps and let’s get on it and we are able to repair it. It’s not an issue. That’s what education’s for.” So I feel we’ve nice alternative right here to, as I mentioned earlier, normalize that in order that it is not a judgment that you just’re not prepared however it’s extra “Hey, it is our job to get you prepared. That’s why we’re right here.”
Unger: It’s humorous as a result of there’s disruptions throughout, mainly, the spectrum of all work and we’ve a cohort of parents which might be going to transfer by the place these gaps are actual and can need to be addressed over the course of time. But regardless of the influence of the pandemic, that has not dampened people’ enthusiasm for making use of to medical college. Dr. Lomis, what do you assume about how this pandemic goes to affect the longer term well being care workforce?
Dr. Lomis: Well, as you know, Todd, we have seen growing numbers of candidates to medical college and the brand new information about matriculation this yr is obtainable now and really fairly promising that not solely functions went up however we’ve precise matriculants in areas with college students who’re from backgrounds which have been traditionally marginalized or underrepresented. And so there’s some good headway there. One notable exception is, sadly, Native American, we did not make progress there however it’s nice to see growing variety within the incoming courses. And considering by how troublesome this time has been for well being care suppliers, to see that younger individuals are impressed to enter the sphere presently is especially gratifying. It goes to be necessary to us to keep our give attention to constructing out holistic and equitable methods of choosing folks as a result of as extra candidates come forth, it would imply, sadly, that some actually nice potential candidates get turned away. And we wish to do this primarily based on the issues that really relate to success throughout the career and never among the historic metrics which have been weighed onto closely. So it is going to be a problem to us to make it possible for we hold pushing ahead with that holistic view.
Unger: Well, we’ve been coping with this pandemic now for the higher a part of two years. And our AMA president, Dr. Gerald Harmon, lately authored a viewpoint about his concern for brand spanking new physicians coming into medication in the course of the pandemic. Are you seeing the type of fatigue and burnout with residents, significantly these on the entrance strains, and the way is AMA addressing this concern? Dr. Andrews?
Dr. Andrews: Yeah, it is a massive concern. I imply, doctor well-being and burnout on the doctor workforce was a priority, as I mentioned, earlier than the pandemic however the pandemic has actually highlighted that and exacerbated it. For residents, the calls for of responding to COVID pandemic have been important. And working in methods the place there’s uncertainty about how to deal with these sufferers, uncertainty about the amount of sufferers that they are going to need to deal with, watching sufferers die frequently has been an enormous burden and definitely compromises well-being. I’ll say that I feel that there are some moderating components. I do assume that residents take some satisfaction in the truth that they’re on the entrance strains for responding to this pandemic that is a supply of nationwide concern and are happy that they are within the medical career for that cause. So there are some balancing components however by and enormous, I feel there’s numerous well-founded concern about burnout.
The AMA is working with residency packages and with well being methods to present entry to screening instruments for burnout, in order that packages and well being methods perceive how massive an issue it’s. Through the Steps Forward program, there are frameworks and different approaches that, once more, packages and well being methods can take to create environments which might be much less possible to exacerbate burnout and handle among the compromised well-being that individuals are experiencing. But I feel it is going to be an ongoing problem and we do not have all of the solutions but. Our continued consideration to it, sensitivity to it, and our curiosity in on the lookout for the situations the place it is actually compromising folks’s capability to be efficient at work and to really feel snug going residence at evening goes to be a spotlight of our curiosity going ahead for a very long time, I feel.
Unger: Dr. Lomis, what about medical college students in the identical realm?
Dr. Lomis: Well, I feel, like all members of the well being professions, medical college students actually felt the pressure of this, the combination of each the problem of what scientific work they have been in a position to do, plus the disruption to their ahead path. And, as you know, medical college students are very targeted on the longer term and shifting ahead, and in order that was significantly anxiety-provoking for them. And I feel the entire colleges labored very laborious to assist their college students throughout this time. And it is much more regarding the latest declaration from the surgeon basic about the psychological well being disaster amongst our nation’s youth. That is our future medical scholar physique. And so we need to proceed to assume throughout, even earlier, within the instructional continuum about this notion of well-being.
We truly spent a while this yr in our consortium targeted on the well-being of the medical educators, as a result of a lot of them are additionally clinicians, in order that they have been feeling the pressure of adapting their scientific duties and responding to the wants of COVID sufferers or different wants of the well being system, whereas concurrently having to redesign instructional packages and assist their college students, who they care about they usually noticed the angst that they have been going by. And so we truly labored rather a lot with our school throughout the nation to perceive among the drivers of their pressure and the way we’d higher assist them so that they are nonetheless there to educate the scholars sooner or later. And so devoting a while to placing collectively some sources for organizations to actually assume about how will we construct in higher surge capability for the education discipline? It’s often run on a string. And so we’re placing that forth within the new yr, some pointers about how a corporation can assist the well-being of the academic school.
Unger: Well, that is a very good—
Dr. Andrews: And if I might—
Unger: Yeah, go forward.
Dr. Andrews: If I might simply soar in, one of many necessary factors behind what Dr. Lomis simply highlighted is the truth that these educators are position fashions for the scholars and the residents whom they’re coaching. And if the scholars and residents see that these position fashions aren’t discovering pleasure of their career, that additional compromises the entire system as a result of these trainees are saying, “Well, what am I getting myself into if 20 years from now, I’m going to be feeling the way in which I see this particular person feeling now?” So it is actually vital that we handle these considerations about burnout and well-being throughout the spectrum of doctor skilled growth.
Unger: Well, then that is clearly going to be a giant piece of the longer term for 2022. As you look forward to the approaching yr, what do you assume the opposite type of largest alternatives are for the AMA to assist medical college students’ residency and the oldsters that you just simply talked about who’re mainly guiding that studying, educating them to grow to be leaders in healthcare? Dr. Lomis, why do not you begin?
Dr. Lomis: Sure. Well, I feel what we noticed in the course of the pandemic was that among the issues that we, as AMA, have been beforehand invested in, truly turned out to be critically necessary in a time of disruption like this. So sadly, the pandemic was a crash course for everybody in well being system science. And we had already devoted closely into coaching college students and residents and college, for that matter, in higher understanding the methods through which they work and the way they contribute to the development of these. And so we, thankfully, had sources at hand that many colleges avail themselves of to assist ramp up that coaching actually rapidly. So we hope to see the continued propagation of coaching throughout the continuum in these ideas.
Certainly, we have been invested in what we name competency-based education, which actually, as an alternative of claiming, “How lengthy have been you in a course,” it seems to be at “What did you be taught and did you attain the outcomes that you just need?” And so whenever you see a disruption through which time goes away, it was actually beneficial to have colleges that had a greater deal with on the place every particular person scholar was as a result of they have been routinely assessing their progress and will discover different pathways, once more, to hold them shifting ahead and get to the place they need to be. And that ended up connecting to some work that we have achieved in value-added roles with college students, this notion that the scholar isn’t just receiving, they usually give rather a lot. We have extremely shiny and proficient medical college students who can do numerous various things. And so we have been in a position to articulate that and hope to proceed to construct that understanding of the worth that they bring about to the well being care system.
And then different ideas, we have been considering rather a lot about how to be a grasp adaptive learner. Certainly, everybody had to adapt on this state of affairs. And I feel, shifting ahead, we know that there is going to be an increasing number of ambiguity, and we’re going to need to adapt to new and evolving applied sciences, equivalent to synthetic intelligence and the world of huge information. And then, in fact, all through all of this, we’ve all grow to be way more attuned to ideas of fairness. And so we’ll proceed to find a way to convey that lens to the entire issues that we do and actually assume with way more broad views than we could have prior to now.
Unger: All proper. We’ve been asking a lot of completely different people, over the course of the previous few months, the phrases they’d use to describe this previous yr. I feel adapt would most likely be in my prime two. Dr. Andrews, once more, as you look ahead to 2022, what’s your principal space of focus? How is the AMA going to assist?
Dr. Andrews: Yeah, I feel that Dr. Lomis’ feedback have been fairly complete. She highlighted many of the necessary points. I’d simply emphasize a few issues. This effort to pursue competency-based medical education, I feel is actually necessary. For the explanations that we said earlier, we’ve college students graduating from medical college who’re involved about gaps of their coaching. What are these gaps, and will we truly know what they’re able to? And the place these residents are involved, who’re in search of board certification, relatively than simply spending three years in inner medication residency, will we know that they’ve achieved the requirements mandatory to apply independently? And that places numerous stress on us, as a medical education neighborhood, to refine our assessments in order that we are able to truly know what individuals are able to relatively than simply how lengthy they’ve spent doing it.
And then the opposite factor, I feel it is actually necessary to handle is the problem of variety within the doctor workforce and in our medical education methods. I imply, COVID, as soon as once more, has highlighted that there are large inequities. And as we take a look at the disproportionate influence of COVID, significantly in communities represented by individuals of colour, we take a look at our medical education system and see how poorly represented individuals of colour are inside that system. And we’re going to have to do one thing about that to meet the wants of these communities with a doctor workforce that higher represents the sufferers for whom they’re offering care.
Unger: Well, Dr. Andrews and Dr. Lomis, thanks a lot to you and your colleagues for all of the work you have achieved to assist college students and residents and to the consortium and to all our GCEP companions on the market as properly. This has been fairly a yr and I admire your insights as you type of look again and look ahead on medical education. Thanks for being right here as we speak. We’ll be again quickly with one other Moving Medicine video and podcast. Be positive to click on subscribe on the AMA’s YouTube channel, Apple, Spotify or wherever you hear to your podcasts. You can discover all of our podcasts and movies at ama-assn.org/podcasts. Thanks for becoming a member of us. Take care.
Disclaimer: The viewpoints expressed on this video are these of the members and/or don’t essentially mirror the views and insurance policies of the AMA.