Letters to the Editor
In reply to Shah et al: We agree it would be desirable if educators could find a way for residents to focus on their unique interests in training while also mastering the competencies essential for independent practice. Our study demonstrated that internal medicine research pathway candidates, typically gifted learners, who did one less year of clinical training did not appear any less clinically prepared for practice.
The Next Accreditation System (NAS) has the potential of better determining whether a resident has mastered the essential competencies for unsupervised practice before allowing the resident to concentrate on an interest area. NAS is scheduled to begin for some specialties in July 2013 and focuses on educational outcomes in the six competencies established in 1999 by the Accreditation Council of Graduate Medical Education and the American Board of Medical Specialties.1 The goal of NAS is to depart from the current formal training structure that is process based to one that measures educational milestones that are developmental and specialty-specific. This approach would allow residents in the same program to master competencies at different rates and encourage those who do so early to innovate and concentrate on specific interest areas. The ability to pursue a more individualized program could, as Shah et al suggested, help to reduce burnout.
Some controversy exists over whether the competency-based system for internal medicine would support a reduction in residency training to fewer than 36 months.2 The current thinking of the Internal Medicine Education Redesign Task Force II2 is that time in residency would remain the same but residents’ activities would vary: Some would work to address deficiencies while others would pursue enrichment experiences. The task force agreed that a 36-month duration was necessary to experience a diverse array of patients and to understand all aspects of longitudinal care, including interpersonal and professional skills.
As the new NAS system evolves, the issue of duration will inevitably be revisited. For now, outcomes-based education is a step in the right direction, as it allows residents to focus on their interests once they have mastered the essential competencies.
Rebecca S. Lipner, PhD
Senior vice president of evaluation, research and development, American Board of Internal Medicine, Philadelphia, Pennsylvania; firstname.lastname@example.org.
Eric S. Holmboe, MD
Senior vice president and chief medical officer, American Board of Internal Medicine, Philadelphia, Pennsylvania.
1. Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system—Rationale and benefits. N Engl J Med. 2012;366:1051–1056
2. Weinberger SE, Pereira AG, Iobst WF, Mechaber AJ, Bronze MSAlliance for Academic Internal Medicine Education Redesign Task Force II. . Competency-based education and training in internal medicine. Ann Intern Med. 2010;153:751–756