Sally A Santen1, Stanley J Hamstra2, Kenji Yamazaki3, Jed Gonzalo4, Kim Lomis5, Bradley Allen6, Luan Lawson7, Eric S Holmboe8, Marc Triola9, Paul George10, Paul N Gorman11, Susan Skochelak12. 1. is Evaluation Consultant, American Medical Association, and Senior Associate Dean and Professor of Emergency Medicine, Virginia Commonwealth University School of Medicine. 2. At the time of writing, was Vice President, Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education (ACGME), and is now Professor, Department of Surgery, University of Toronto, Adjunct Professor, Department of Medical Education, Feinberg School of Medicine, Northwestern University, and Research Consultant, ACGME. 3. , is Senior Analyst, Milestones Research and Evaluation, ACGME. 4. is Associate Professor of Medicine and Public Health Science, and Associate Dean for Health Systems Education, Penn State College of Medicine; at the time of writing. 5. was Associate Dean, Vanderbilt University School of Medicine, and is now Vice President, UME Innovations, American Medical Association. 6. is Senior Associate Dean for Medical Student Education and Associate Professor of Clinical Infectious Diseases, Indiana University School of Medicine. 7. is Associate Dean for Curricular Innovation in Medical Education and Associate Professor of Emergency Medicine, Brody School of Medicine at East Carolina University. 8. is Chief Research, Milestone Development, and Evaluation Officer, ACGME. 9. is Associate Dean for Educational Informatics and Director of the Institute for Innovations in Medical Education, NYU Grossman School of Medicine. 10. is Associate Professor of Family Medicine and Associate Dean of Medical Education, Warren Alpert Medical School of Brown University. 11. is Professor of Medical Informatics and Clinical Epidemiology, Professor of Medicine, and Assistant Dean, Rural Medical Education, School of Medicine, Oregon Health & Science University. 12. is Group Vice President, Medical Education, American Medical Association.
Abstract
BACKGROUND: The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation. OBJECTIVE: This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME). METHODS: ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models. RESULTS: At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups. CONCLUSIONS: Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.
BACKGROUND: The American Medical Association Accelerating Change in Medical Education (AMA-ACE) consortium proposes that medical schools include a new 3-pillar model incorporating health systems science (HSS) and basic and clinical sciences. One of the goals of AMA-ACE was to support HSS curricular innovation to improve residency preparation. OBJECTIVE: This study evaluates the effectiveness of HSS curricula by using a large dataset to link medical school graduates to internship Milestones through collaboration with the Accreditation Council for Graduate Medical Education (ACGME). METHODS: ACGME subcompetencies related to the schools' HSS curricula were identified for internal medicine, emergency medicine, family medicine, obstetrics and gynecology (OB/GYN), pediatrics, and surgery. Analysis compared Milestone ratings of ACE school graduates to non-ACE graduates at 6 and 12 months using generalized estimating equation models. RESULTS: At 6 months both groups demonstrated similar HSS-related levels of Milestone performance on the selected ACGME competencies. At 1 year, ACE graduates in OB/GYN scored minimally higher on 2 systems-based practice (SBP) subcompetencies compared to non-ACE school graduates: SBP01 (1.96 vs 1.82, 95% CI 0.03-0.24) and SBP02 (1.87 vs 1.79, 95% CI 0.01-0.16). In internal medicine, ACE graduates scored minimally higher on 3 HSS-related subcompetencies: SBP01 (2.19 vs 2.05, 95% CI 0.04-0.26), PBLI01 (2.13 vs 2.01; 95% CI 0.01-0.24), and PBLI04 (2.05 vs 1.93; 95% CI 0.03-0.21). For the other specialties examined, there were no significant differences between groups. CONCLUSIONS: Graduates from schools with training in HSS had similar Milestone ratings for most subcompetencies and very small differences in Milestone ratings for only 5 subcompetencies across 6 specialties at 1 year, compared to graduates from non-ACE schools. These differences are likely not educationally meaningful.
Authors: Jed D Gonzalo; Paul Haidet; Klara K Papp; Daniel R Wolpaw; Eileen Moser; Robin D Wittenstein; Terry Wolpaw Journal: Acad Med Date: 2017-01 Impact factor: 6.893
Authors: Jed D Gonzalo; Michael Dekhtyar; Stephanie R Starr; Jeffrey Borkan; Patrick Brunett; Tonya Fancher; Jennifer Green; Sara Jo Grethlein; Cindy Lai; Luan Lawson; Seetha Monrad; Patricia O'Sullivan; Mark D Schwartz; Susan Skochelak Journal: Acad Med Date: 2017-01 Impact factor: 6.893
Authors: Jed D Gonzalo; Elizabeth Baxley; Jeffrey Borkan; Michael Dekhtyar; Richard Hawkins; Luan Lawson; Stephanie R Starr; Susan Skochelak Journal: Acad Med Date: 2017-01 Impact factor: 6.893
Authors: Andrea N Leep Hunderfund; Liselotte N Dyrbye; Stephanie R Starr; Jay Mandrekar; James M Naessens; Jon C Tilburt; Paul George; Elizabeth G Baxley; Jed D Gonzalo; Christopher Moriates; Susan D Goold; Patricia A Carney; Bonnie M Miller; Sara J Grethlein; Tonya L Fancher; Darcy A Reed Journal: Acad Med Date: 2017-05 Impact factor: 6.893
Authors: Jed D Gonzalo; Kelly J Caverzagie; Richard E Hawkins; Luan Lawson; Daniel R Wolpaw; Anna Chang Journal: Acad Med Date: 2018-06 Impact factor: 6.893
Authors: Amy W Shaheen; Kelly Bossenbroek Fedoriw; Susanna Khachaturyan; Beat Steiner; Julie Golding; Julie S Byerley; Gary L Beck Dallaghan Journal: Am J Med Date: 2019-09-04 Impact factor: 4.965
Authors: Jed D Gonzalo; Anna Chang; Michael Dekhtyar; Stephanie R Starr; Eric Holmboe; Daniel R Wolpaw Journal: Acad Med Date: 2020-09 Impact factor: 6.893
Authors: Stanley J Hamstra; Kenji Yamazaki; Melissa A Barton; Sally A Santen; Michael S Beeson; Eric S Holmboe Journal: Acad Med Date: 2019-10 Impact factor: 6.893