Welcome to Philadelphia! We are looking forward to this year’s AAMC Annual Session – a little closer to our home across the Ben Franklin Bridge this year. Follow us as we live blog and learn together!
Saturday, November 2
Leadership Plenary: Our Moment of Truth
AAMC President & CEO Dr. Darrell Kirch discussed his own “moments of truth” through his career, and asked us to consider our own – and how we made decisions in tough situations. And how sometimes we avoided making decisions – and how this was a decision itself.
We will have shared moments of truth together over the coming years – when we must make the difficult decisions that will impact the health of the nation.
Leadership Plenary: Leading the Dance of Change
Dr. Valerie Williams took the crowd through the options of the pace of change by way of a tour of dancing: The Waltz (traditional, stable, organized – as long as everyone moves in the same direction); The Twist (all about personal style – no matter if everyone dances on their own – but inefficient and non-cooperative); the Line Dance (structured and orderly, but one misstep by an individual impacts everyone else – structure and order are necessary, but not adequate); The Tango (powerful, fearless – a combination of order and risk-taking).
We must adapt our leadership skills to the challenges – we must be prepared for “sustained disequilibrium”, ongoing experimentation, and a changing environment.
Annual Address on the State of the Physician Workforce
The past ten years have seen a decrease in the number of rural and African Americans entering medical schools. If the current increase in residency slots of 1% per year continues we will have 2000 less positions than graduates by 2021. 35% of the IMGs applying for residency slots are now from Carribbean schools. There has been an increase in nurse practitioners by 60%. Studies show that 50% of patients do not mind seeing an extender and that number increases if it means being seen sooner. The prediction is that 50% of the physician shortage will be in primary care areas. Schools should give students good role models in primary care. The decline in interest in primary care may be ending. The ACA will amplify the physician shortage numbers.
Education meets Analytics
What we need from analytics: Competency verification (of students AND faculty); Counseling for individual learning needs – help students self-assess; Behavior Modification – help students/faculty see how and why different areas are important in the curriculum; Accreditation – of course; Curriculum evaluation
Hazards: Overwhelming people with data; Unhealthy competition among students; Heisenberg effect
Colleges are great at collecting data, but not very good at dispensing that information back to the students. What data should be shared with students, and who makes that decision? In a perfect world, students should be able to have access to their data (it is their data after all) whenever possible.
Preparing Your Institution for a Post Fee-For-Service World
Provided an interesting set of principles to lead health care organizations from fee-for-service to a value-based system. An emphasis was placed on communications, preparing systems, empowering people, customized strategic planning, and rewards and recognition. The value of visiting places that are innovators in this area was emphasized. The importance of getting an idea of true costs vs charges was presented. Accurate knowledge of costs unlocks opportunities in process improvement. Some articles from Harvard Business Review were cited and discussed.
Evidence-based approaches to promoting diversity in the academic medicine workforce
Great session presenting three different studies examining factors that impact career trajectories for clinical and research faculty. Controlled studies/analyses of existing mentoring approaches, academic milestones, and implementation of new “coaching” models all addressed current successes and failures in building diverse faculty at academic medical centers. One study highlighted that actual conversations are central to promoting change, and virtual or distance efforts to address practices/attitudes do not effectively pave the way for true discussions regarding culture change.
A healthcare delivery model that integrates legal care directly into patient healthcare, and uses three levels of legal intervention: 1) at the patient, 2) at the clinic, and 3) at policy levels — to address and prevent health-harming legal needs. Concepts for interprofessional education of medical and law students were discussed. An outline for a 4 year curriculum was presented. Great ideas for our schools
Six year elections are typically difficult for the party in power in the white house – so, expect loss of democratic seats in both houses of Congress. Very few house seats will be likely to change due to redistricting/gerrymandering and the resulting “safe” seats for both parties – only around 15% of seats are up for grabs. Polling shows that 47% of respondents thought ACA was a bad idea, but only 24% thought it should be completely repealed.
As Ohio goes, so goes the Nation: Shift in statewide elected officials from Democrat -> Republican in 2010 – Democrats lost ability to control redistricting… Gerrymandering created the model of “safe districts” for parties – heavily weighted towards R.
Efficiency, Accountability, and Sustainability: Alternative Models of Medical Education
Buzzwords in this session title were expanded upon – presenting three models of med ed that addressed combining M4 with residency in primary care, an accelerated back to MD, and an accelerated PhD in basic science to MD. Each presented possibilities that are creative and sustainable, but are complicated by the current structure of GME. Key to success in med ed innovation begins with the ACGME. “Competence, not time, should be the benchmark of med ed” — a Sal Khan-esque approach to medical education! We must continue to be innovative in our approach – particularly to the M4 year.
The Jaws are closing on Unmatched Students: Engaging National and Local Perspectives
Lively and busy session today!
Unfilled positions are decreasing as more students are applying. Students don’t match for a short list of reasons: 1) competitiveness (didn’t rank enough programs, too competitive specialty), 2) USMLE scores too low, 3) poor interview/interpersonal issues, 4) overly aggressive rank order list. Schools must counsel students – especially those “at risk” (competitive specialty, below average performance, couples match, etc.) to have a “parallel” plan for less competitive specialty or other option (MPH, etc.). VCU uses match survey, identifies students by red/yellow/green with regard to risk of not matching – identify EARLY and counsel on options, etc.
Council of Faculty and Academic Societies (CFAS)
The inaugural session of this group was held today. CFAS was created to provide a voice for medical school faculty (128,000 strong nationwide!) within AAMC. A few key issues affecting faculty that were identified in today’s session:
1) Increased emphasis on faculty clinical productivity over research and teaching
2) Effects of health system aggregation on the role/value of academic faculty
3) Federal fiscal crisis impact on sustainable research agenda
Implementing the Health Care and Diversity Imperatives in the Post-Fisher World
Successful policy development includes the following: sound educational basis, support by key stakeholders, clear mission/goals, and is lawful. The goal should be preparing effective, culturally competent physicians. Institutions need to develop metrics and track the benefit of a diverse, inclusive student body, in order to demonstrate efficacy of holistic admissions measures. Evidence can include student surveys, alumni surveys, patient outcomes, etc. Metrics matter!
Bridging the industry-academia divide to advance discovery
84% of drug discovery over last decade is from academia. There is a revenue stream from this – and institutions must manage the conflict of interest. Implicit in the push for translational research is commercialization (per the NIH). The curriculum must include instruction in conflict of interest. (and CMSRU has this embedded in our Scholar’s Workshop course!)
Health Care Improvement: effecting and Studying Change Thru Continuing Education, Professional Development, and Lifelong Learning
Important link all three of these approaches. The new equation is Value = Quality/Cost + Pt Centeredness. Consider changing “CME Office” to “Office of Integrated Professional Development”. It’s critically important to focus on the continuum of medical education – undergraduate, graduate, and continuing.
Friday, November 1
Working Within a Team: Navigating Difficult Conversations
This session dealt with preparing students for difficult conversations in the health care setting. How should they respond as members of the health care team when they observe something that isn’t standard of care or something occurs that is a patient safety issue? How do we empower students to speak up without fear of reprisal? Simulation would be a good venue to learn and practice having crucial conversations. OSCEs would a good way to assess student skill in this area.
Future of Medical Education: Opportunity, Innovation, and You—Sponsored by the GRMC.
Regional campuses may be ideally suited for innovation. A variety of innovations were discussed: LIC implementation at regional campuses, interprofessional education, early learners as patient navigators, restructuring the fourth year, faculty development in 10-15 minute sessions posted on U tube, and partnering with other schools to develop a digital library of lectures by premier faculty.
The four sections of the new MCAT for 2015 were reviewed. A validity study is in progress. In 2013 there were 48,014 applicants to allopathic schools in the US and for the first time enrollment was > 20,000. Applicants apply to 15.4 schools on average. Applications from Hispanic/Latino students have increased to 1826 and women comprise ~47% of the pool. 26% of enrollees are socio-economically/ educationally disadvantaged based on parental education and occupation. 19% are first generation college graduates.