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Preparing Residents for Practice in New Systems of Care by Preparing Their Teachers

Kogan, Jennifer R. MD; Holmboe, Eric S. MD

doi: 10.1097/ACM.0000000000000480
Responses to the 2014 Question of the Year

Dr. Kogan is associate professor of medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Holmboe is senior vice president, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Kogan, 3701 Market St., Suite 640, Philadelphia, PA 19104; telephone: (215) 615-0503; e-mail:

The health care delivery landscape is rapidly changing; these changes require physicians to develop new competencies so they can provide high-quality patient care. The medical education system must also change in order to prepare a physician workforce that is ready to meet the needs of patients within this evolving health care system. Graduate medical education (GME) training involves predominantly experiential, workplace-based learning in which residents are taught and supervised by their near-peers and faculty. These faculty must be able to model, teach, assess, and remediate the emerging competencies now essential to improving the health of patients and populations. These competencies include patient-centered communication, shared decision making, high-value care, meaningful use of health information technology, and interprofessional team-based care.

Importantly, for faculty to act as models for and to teach, assess, and remediate learners, they must possess and demonstrate good, if not excellent, competencies in the domains they are working to develop within their trainees. Yet, deliberate education in many of the emerging competencies (e.g., patient-centered communication, high-value care) during residency is relatively nascent. Most faculty, therefore, are unlikely to have explicitly learned such competencies during their own training. Further, they are unlikely to have had significant formal education in them as part of continuing professional development. Therefore, going forward, to be effective teachers, clinical faculty members will themselves need training in many of the emerging competency domains.

Although competencies and milestones have been articulated for most specialties, few faculty have had meaningful explicit training in assessing trainees in their attainment of these competencies, especially in newer competency domains. If the U.S. GME system is to prepare trainees for practice in new systems of care delivery, the medical education community must invest in clinician–educator faculty, helping these faculty to learn and refine their skills in teaching, assessing, and remediating resident learners to ensure that the latter are ready for unsupervised practice.

For too long, faculty development has been developed within single institutions as discipline-specific, one-time workshops or seminars, focusing preferentially on teaching skills, potentially at the expense of clinical competencies. There is tremendous need for faculty, at a national level, to acquire new clinical and system-based knowledge and skills in a short period of time.1 Therefore, the medical education community must invest in new national infrastructures for faculty development. Many of the emerging clinical and teaching skills that are believed to improve health and health care are not discipline-specific; they are, rather, applicable to practicing physicians more broadly. As such, a national platform for faculty development could afford economies of scale. With the advent of such a platform, institutions and medical specialties would no longer need to create faculty development programs in silos but could, instead, collaborate and share best practices and lessons learned. Content germane across disciplines, such as a shared understanding of the “new” competencies (e.g., patient-centered communication) and mechanisms to support longitudinal “back home work” (e.g., implementing a curriculum to improve shared decision making) could be collectively developed by national leaders with content expertise and educational expertise. Individual specialties and institutions might then focus on developing additional content and training that reflects discipline-specific content or local context. An available interactive toolbox of resources for program directors to use with their faculty or for faculty to use individually could increase time spent learning and practicing, and decrease time spent developing new programs that are similar to, overlap with, or reproduce programs that exist elsewhere. A national faculty development infrastructure would also support institutional, regional, or even national communities of learning. Ideally, a component of the faculty development would be situated in the workplace to enable clinician–educators’ own deliberate practice to longitudinally improve their own competencies in teaching and in clinical care.

One benefit of this more coordinated faculty development approach would be the opportunity to study faculty development effectiveness more systematically. There is an enormous need for studies that use rigorous research methods and are based on a clear conceptual framework, that gather data from multiple sources through validated instruments, and that measure changes in the behavior of individuals and in organizations (e.g., improved patient outcomes, a more collaborative culture).1,2 Such research could also serve as an ongoing feedback loop, improving both GME and continuing professional development. Currently, such quality improvement feedback is largely missing from our health care and medical education systems.

Now is the time to reconceptualize faculty development as a means not only to enable faculty to learn new competencies that they can apply to the care of their own patients but also to improve their ability to model, teach, assess, and remediate the very competencies their GME trainees must master, competencies that are essential to improving the health of patients and populations. For this to be successful, there must be local and national buy-in to the belief that it is fundamentally necessary to support clinician–educators in the development of their skills as clinicians and teachers.

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1. Leslie K, Baker L, Egan-Lee E, Esdaile M, Reeves S. Advancing faculty development in medical education: A systematic review. Acad Med. 2013;88:1038–1045
2. Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No 8. Med Teach. 2006;28:497–526
© 2014 by the Association of American Medical Colleges