Thursday, March 1, 2012

Dear ACGME: Please be careful

US News and World Reports must be licking their chops.

The New England Journal of Medicine has published a special report, "The Next GME Accreditation System — Rationale and Benefits."  The report outlines a new process for quality control and accreditation standards for graduate medical education.  This system will be piloted in 7 specialties, including EM, in 2013.  It will be implemented for the remaining 19 ACGME specialties in 2014.

The report cleverly seems to be a call-to-arms to rally the GME community to herald the new program, instead of fight it.  The ACGME is about to implement a very powerful tool which is greatly needed and right in concept and principle.  However, lost in the enthusiasm of the announcement are the dangers involved in wielding such a powerful tool.  The reports "limitations" section is short, and mostly addresses conceptual limitations that the ACGME seem to already have solutions for.

There is one particular sentence in the report that I found concerning:

"The process will generate national data on program and institutional attributes that have a salutary effect on quality and safety in settings where residents learn and on the quality of care rendered after graduation."

To me, this means that soon there will be a rankings list for residencies.

I ranked BIDMC/HAEMR first, and I was lucky enough to match here.  But I ranked it first because it was first for me.  It represented to me, the program that would create the most opportunity to be the particular brand of doctor that I want to become (namely, an educator, an innovator, a leader, and a practitioner).

Take a look at what pops up when you search best emergency medicine residencies on Google.  There is no list.  Instead, there are discussions about going to the program that will make you the happiest.  In a world where US News and World Reports dictates so much of our views on what's good and what's not, this freedom from rankings should be valued and protected.  It is this freedom that allows students to break free of the undue pressures that have dictated so many of their decisions in the past, and make a life-choice based on what is truly best for them.

The ACGME has a responsibility to protect this special attribute of the match process.  I hope they will address this concern directly when implementing NAS.

See the full report here

- Teach, MD

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