[The following notes were generated by Andrea Belovich, PhD.]
In response to the enthusiastic reception of the IAMSE Winter 2021 WAS series, “The USMLE Step 1 is Going to Pass/Fail, Now what do we do?,” an additional webinar was presented by Dr. Elise Lovell, Clinical Professor of the University of Illinois at Chicago and Co-Chair of the Coalition for Physician Accountability UME-GME Review Committee (UGRC) on February 25th, 2021. During this sixth and final webinar, made available free-of-charge to registrants, Dr. Lovell provided a cutting-edge update of the UGRC’s work to review the transition from Undergraduate Medical Education (UME) to Graduate Medical Education (GME).
Dr. Lovell began by introducing the composition and mission of the Coalition for Physician Accountability. The Coalition is a collaboration between the national organizations responsible for the education, assessment, accreditation, certification, and licensure processes ranging from UME to practicing physicians. (A full list of member organizations is available on the Coalitions’ website [1].) As a collective, the Coalition’s mission is “to advance health care and promote professional accountability by improving the quality, efficiency, and continuity of the education, training and assessment of physicians” [2].
To provide the audience with context for the development of the Coalition’s UGRC, Dr. Lovell shared the four recommendations resulting from the Invitational Conference on USMLE Scoring (InCUS) in March 2019:
- Consider score reporting changes, e.g., pass/fail; composite score; categorical/tiered scoring for USMLE
- Research on how USMLE is (or is not) related to performance in residency and/or practice
- Continue work to address group (racial/demographic) differences in USMLE
- Undertake comprehensive overview of UME-GME transition system
Dr. Lovell emphasized that while the first recommendation regarding the USMLE Step 1 P/F scoring has received significant attention from the medical education community, the InCUS recognized that the USMLE Step 1 numerical score was merely one factor of many that contributes to the broader problems surrounding the UME-to-GME transition. After briefly discussing the progress being made towards meeting the first three recommendations, Dr. Lovell focused on the fourth InCUS recommendation: the review and overhaul of the current UME-GME transition system. This review process was anticipated to involve eight major areas of focus: 1) Improving the application process, 2) Reducing the number of applications submitted by applicants, 3) Improving transparency of the UME-GME transition process, 4) Identifying potential adjustments to the Match, 5) Improving Program Directors’ ability to more holistically review applicants, 6) Improving the trust/transparency of medical school-based assessments, 7) Reviewing the role of standardized testing in UME-GME transition, and 8) Developing assessments for other important measures beyond knowledge.
As the InCUS developed the recommendation to review the UME-to-GME transition, the Coalition for Physician Accountability was identified as the organization best suited to addressing the task. In September of 2019, the Coalition formed a Planning Committee (PC) to identify the construct and membership of the UME-GME Review Committee (UGRC), develop a process for selecting UGRC membership/leadership, and determine key questions, deliverables, milestones, timeline, and budget for the UGRC.
As a result of the PC’s efforts, membership of the UGRC is comprised of representatives from each of the Coalition member organizations, as well as medical students, resident physicians, members of the public, and support staff. Along with Dr. Lovell, Dr. George Mejicano was selected to co-chair the UGRC. Areas of focus for the UGRC were identified to include fit of applicants for residency programs based on abilities and interests, increase of trust between medical schools and residency programs, and mitigation of reliance on licensing exams during the application process. In addition, the UGRC’s focus encompasses ensuring fairness for all types of applicants (allopathic, osteopathic, and international medical graduates) while considering cost and the potential for systemic bias and diversity issues throughout the transition from UME to GME. The broader scope of the UGRC was also determined to include consideration of specialty-specific competencies, including when and how specialty-specific preparatory training for residency should occur, as well as where responsibility should rest in resolving any gaps in residency readiness.
Once established, the UGRC created four work groups to address the charges from the Coalition’s Planning Committee, and added their own overall considerations of diversity, equity, inclusion, fairness, student wellbeing, and the public good. The work groups were also asked to proactively anticipate outcome assessment of their recommendations and to plan for research for continual modification to support the formation of an iterative review process of the UME-GME transition going forward.
Work Group A’s focus is on ensuring residency readiness by identifying competencies students should be learning during UME and improving the advising process as students choose residencies for application. Work Group B’s charge is to improve the mechanics of the application/election process from the UME perspective, which includes information sharing by medical schools with residency programs, residency application content, and application mechanics (e.g., away rotations, etc.). Work Group C’s task is to improve the mechanics of the application/election process from the GME perspective, including information sharing by residency programs with medical schools, interview processes, and the match process with an emphasis on considering financial and opportunity costs to students. Work Group D is concerned with post-match optimization and improving the “soft transition” into residency during the fourth year of medical school. In particular, this group is addressing how to ensure that junior residents are prepared to meet specialty-specific competencies and how responsibility for any readiness gaps should be shared in the interest of patient safety and students’ professional development. This process is anticipated to involve information sharing/feedback from the residency program back to UME in order to more successfully educate and prepare future students.
Dr. Lovell then provided an overview of the UGRC’s process and work-to-date. Following up from a well-planned and intentional virtual brainstorming session held January 14th and 15th, 2021, the UGRC’s work groups have achieved/established the following: 1) Communication framework including bi-directional Stakeholder engagement; 2) Central Repository for reference literature; 3) Work Group level-setting (defined present status of UME-GME transition and data resources); 4) Root cause analysis of current problems; 5) Consideration of “what’s good/worth keeping” from current state; 6) Envisioned success, including measurement of outcomes; 7) Solicited Stakeholder visions of the transition’s future Ideal State.
Dr. Lovell then invited audience members to follow UGRC meeting updates on physicianaccountability.org, and provided an expected timeline for the delivery of the URGC’s recommendations, which are currently being built. These draft recommendations will be reviewed by the UGRC in March 2021, and made available for public review in April 2021. Final UGRC recommendations are expected to be delivered to the Coalition for Physician Accountability in May 2021.
The URGC is currently seeking UME-to-GME innovation input from stakeholders, which will be accepted through March 12th, 2021 [3].
References:
- Coalition for Physician Accountability. https://physicianaccountability.org/members/
- Coalition for Physician Accountability. https://physicianaccountability.org/about/
- “UME-to-GME Review Committee (UGRC) Seeks Input on “Innovations” being Used in UME-to-GME Transition.” Coalition for Physician Accountability. https://physicianaccountability.org/wp-content/uploads/2021/02/UGRC-Innovations-Invitation-1.pdf