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Does med school prepare you for residency? What is competency-based medical education? What is an example of competency-based education?

Our guests are Laura Edgar, EdD, senior vice president of competencies, milestones, and faculty development at the Accreditation Council for Graduate Medical Education; Lisa Howley, PhD, MEd, senior director of transforming medical education at the Association of American Medical Colleges; and Mark Speicher, senior vice president of research, learning, and innovation at the American Association of Colleges of Osteopathic Medicine. AMA Chief Experience Officer Todd Unger hosts.

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Speakers

• Laura Edgar, EdD, senior vice president of competencies, milestones, and faculty development, Accreditation Council for Graduate Medical Education; 
• Lisa Howley, PhD, MEd, senior director of transforming medical education, Association of American Medical Colleges
• Mark Speicher, senior vice president of research, learning, and innovation, American Association of Colleges of Osteopathic Medicine

Edgar: It was really fun to see this group come together from across, not only across the country, but across two different philosophies behind how they do their education and how they practice medicine.

Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about a new effort to improve the transition to residency with a more unified approach to medical education. Joining us are three guests who helped to bring this ambitious initiative to life. 

Laura Edgar is the senior vice president of competencies, milestones, and faculty development at the Accreditation Council for Graduate Medical Education, or ACGME, in Chicago. Lisa Howley is the senior director of transforming medical education at the Association of American Medical Colleges in Washington, DC. And Mark Speicher is the senior vice president of research learning and innovation at the American Association of Colleges of Osteopathic Medicine in Bethesda, Maryland. 

I'm Todd Unger, AMA's chief experience officer in Chicago. Laura, Lisa, Mark, what a great team. I'm so excited to have all three of you on the AMA Update today and eager to get into this. We all know the transition from medical school to residency can be a very, very challenging one. I think it's probably been the inspiration for many programs that are on television today. Why don't we just start, Lisa, with a little bit of background about the work that your team did and how it helps to ease this transition? 

Howley: Well, thank you so much, first of all, for having us and the opportunity to share this project which we're very excited about. So what we're talking about today are the new foundational competencies for undergraduate medical education. These were released on December 12, so not that long ago, by our three organizations, So of course AAMC, ACGME and AACOM. 

And the reason for them, there are actually many reasons. But in short, I will summarize by saying that we need to do a better job when it comes to competency-based education, especially at the undergraduate level of medical education or the medical school level of education. 

We've been working at this for decades, actually, across the continuum. But this is the first time that we now have some consensus on what it means to be competent and ready to transition on from UME to GME in the undergraduate space, and across MD and DO-granting medical schools, and importantly, what are those outcomes we expect that align with graduate medical education. So really excited, one, well, to be here today, of course, with you, but to be talking about this work, again, that was just recently released. And we're really excited about this in academic medicine. It's a pretty big milestone for us. 

Unger: I can tell. Thank you, Lisa. And as part of this work, you also made it a priority to incorporate the unique contributions of DO schools and their students. Mark, why don't you tell us a little bit more about that? 

Speicher: Yeah, thanks. And thanks for letting us be here today. And I hope your listeners really enjoy this update. Our physicians have the degree DO, that's Doctor of Osteopathic Medicine. But in the health care system, MDs and DOs all practice together. They treat patients together. Many patients don't know whether they're seeing an MD or a DO. And they train together in residency. 

And so it was important, as we looked across the continuum of medical education, to make sure that residency programs and then subsequently, patients could depend on both MD and DO degree granting schools to ensure that their graduates were well qualified and could be really excellent physicians to improve America's health care. 

Unger: Now, this initiative was a big undertaking in response to a big problem. Lisa, talk a little bit more about the issues with UME to GME transition that this work is intended to address? 

Howley: Yeah. Well, thank you. There are many challenges in that transition and that journey to becoming a physician. One of them is in this transitionary space that has to do with outcomes and thinking about what is it that we're teaching towards and what is it that we're assessing in our undergraduate medical students. 

We knew that for us to do this well, that we needed to work very collaboratively with our colleagues and our fellow medical educators across the continuum, so especially, at that UME and GME level or parts of the continuum. 

So we reached out early to the ACGME and of course, to A-A-C-O-M, AACOM, to launch this program a few years ago now to help us come together around a shared mental model about what it means to be competent, what are those shared common outcomes that we expect of our medical graduates who are transitioning into residency. 

That's going to help in a number of different ways, more time than we have to discuss here. But for example, it really, we hope, will facilitate more of a growth mindset amongst our learners and where they'll be able to see that medical education is a continuum. It is hopefully a more continuous journey as a result of this common framework that, again, is aligned with graduate medical education. 

It will help our faculty develop common assessment strategies or assessment methods for those or towards those outcomes that we now share and expect of our graduates, of our learners. Just to give you a couple examples, right? So it will help develop learners that growth mindset, also faculty to develop assessment systems and programs for a shared outcomes model and framing. 

Unger: Well, that's a great background. I can only imagine the number of stakeholders involved here, the kinds of complexities in a change like this. Laura, talk to us a little bit about what it took to get here. 

Edgar: Oh, my gosh, this was truly a community effort. Besides the three organizations that sponsored this, we had 24 other organizations that served in an advisory capacity. We had another 20-plus members of a development group that actually spent well over a year and many, many hours actually doing the development work of those competencies, and hundreds and hundreds of folks in the community, including we had a student reactor group as well as a patient and caregiver reactor group, which the development group could not have done their work without it. 

And this community is just going to continue to grow as we start to develop learning communities and everybody together, medical students, residents, those in continuing professional development activities, this continuum is so important. And now that we have something showing this transition from medical school into residency, I think it's only going to get better. 

Speicher: Laura, if I could just add that I really do want to point out from the osteopathic medical education community, the groups were fantastic at making sure that the distinctiveness of osteopathic medicine, its holistic approach, its reliance on prevention and on osteopathic manipulation to treat patients was included in the competencies and was represented throughout the process. Because we know there's patients who really want an osteopathic physician and osteopathic physicians graduating in 10 years will still have those same skills and abilities. 

Edgar: Yeah, the collaboration, the diversity, the integration of everybody on the development group was truly incredible. I'm lucky enough in my work to work with a lot of different groups that do development. And it was really fun to see this group come together from not only across the country, but across two different philosophies behind how they do their education and how they practice medicine. It was truly a wonderful experience. 

Unger: Well, Mark, now that these foundational competencies are established and out there, what happens next? 

Speicher: Yeah. The real work is just beginning in many ways. And so we will be working, the AAMC, AACOM and the ACGME, to support all of our schools as they decide whether or not these competencies are right for them. These are not required of any schools. But we know that many of our schools are ready and waiting to incorporate these competencies into their education programs. 

And so we have a learning community of faculty and others who are responsible for the development and implementation of competency-based education at their schools. We're working on some guidebooks and some other written tools. And the three of us will be sponsoring a course this summer and then again in the fall to teach our faculty, teach our assessors how to implement and integrate competency-based education into their programs. So a multiyears long effort, just as developing the competencies was several years long, certainly supporting our schools and encouraging them to implement these competencies will be many years in the making. 

Unger: Well, it sounds like this is kind of a landmark movement here. And what I love, too, is that combination of the MD and DO schools, like you said, two different philosophies of education coming together. So many stakeholders, great teamwork. Anybody else you'd like to give a shout-out to? 

Edgar: Oh, absolutely. We need to give a big shout out to the AMA and Dr. Kim Lomis who served on our advisory committee. The AMA has done some great work in the transition to residency. And so thank you to the organization and to all of your members. 

Unger: Well, we greatly appreciate it. Laura, if medical schools want to learn more about your work, and of course, what it means for them, where should they go? 

Edgar: So we do have a website. And we're going to put that link in the chat for folks to see. It's got all the information, including a series of frequently asked questions. There is a full report on the entire process, as well as a list of all of the foundational competencies. 

There will also soon be a supplemental guide to help explain and provide examples of what those foundational competencies might look like in a medical school, as well as those assessment guides that Mark was speaking about and other tools that we create over time with the learning community. 

Unger: That's excellent. And again, we'll include a link to that in the description of this episode, and of course, any articles that accompany this video in the future. I just want to say, Laura, Lisa, Mark, thank you so much for joining us and telling us more about your work. 

For resources to learn more about these competencies and how the AMA is supporting them, check out the links, of course, in the episode description. And to support the AMA's work, become an AMA member at ama-assn.org/join. That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us. Please take care. 

Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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