Graduate Medical Education
Outcomes and Metrics
PROCEEDINGS OF A WORKSHOP
Payal Martin, Mariana Zindel, and Sharyl Nass, Rapporteurs
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by the Accreditation Council for Graduate Medical Education, Alliance of Independent Academic Medical Centers, American Association of Colleges of Osteopathic Medicine, American Board of Internal Medicine, American Board of Internal Medicine Foundation, American Board of Medical Specialties, American Board of Obstetrics and Gynecology, American Board of Physical Medicine and Rehabilitation, American Osteopathic Association, The Arnold P. Gold Foundation, Association for Hospital Medical Education, Foundation for Advancement of International Medical Education and Research, The Josiah Macy Jr. Foundation, National Board of Medical Examiners, and the U.S. Department of Veterans Affairs (Office of Academic Affairs). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-47121-3
International Standard Book Number-10: 0-309-47121-4
Digital Object Identifier: https://doi.org/10.17226/25003
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Copyright 2018 by the National Academy of Sciences. All rights reserved.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Graduate medical education outcomes and metrics: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25003.
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PLANNING COMMITTEE FOR A WORKSHOP ON GRADUATE MEDICAL EDUCATION OUTCOMES AND METRICS1
DEBRA F. WEINSTEIN (Chair), Vice President, Graduate Medical Education, Partners HealthCare System
VINEET M. ARORA, Director, Graduate Medical Education Clinical Learning Environment Innovation, The University of Chicago
DAVID A. ASCH, Executive Director, Penn Medicine Center for Health Care Innovation
KARL Y. BILIMORIA, Associate Professor of Surgery and Medical Social Sciences, Feinberg School of Medicine, Northwestern University
ROBERT A. CAIN, Assistant Dean, Office of Clinical Education, Ohio University Heritage College of Osteopathic Medicine
CANDICE CHEN, Director, Division of Medicine and Dentistry, Health Resources & Services Administration
MALCOLM C. L. COX, Adjunct Professor of Medicine, University of Pennsylvania
DEBORAH A. DRISCOLL, Luigi Mastroianni, Jr., Professor and Chair, Hospital of the University of Pennsylvania
EDWARD SALSBERG, Director, Health Workforce Studies, Health Workforce Institute, The George Washington University
DOUGLAS S. SMINK, Associate Professor of Surgery, Harvard Medical School, General Surgeon, Brigham and Women’s Hospital
Project Staff
MARIANA ZINDEL MUNDET CRUZ, Research Assistant
KELSEY GEISER, Research Associate (until April 2017)
SHARYL NASS, Director, Board on Health Care Services
Consultant
PAYAL MARTIN, Consulting Writer
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1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
FRANCISCO CIGARROA, The University of Texas Health Science Center, San Antonio
RACHEL KELZ, University of Pennsylvania
DEBORAH POWELL, University of Minnesota Medical School
ERIC SCHNEIDER, The Commonwealth Fund
MEDHANIT TEKLE, Institute for Family Health Harlem
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MOLLY COOKE, University of California, San Francisco. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
We are grateful to the members of the planning committee for the Workshop on Graduate Medical Education Outcomes and Metrics, who collaborated to ensure a workshop with informative presentations and rich discussions, and especially to Debra Weinstein, the committee chair, for her valuable contributions to the development and orchestration of this workshop. We also thank the speakers and moderators, who generously shared their expertise and time to make the workshop a success.
We are also grateful for the coalition of sponsors who supported the workshop, without whom we could not have undertaken this project. The sponsors of the Workshop on Graduate Medical Education Outcomes and Metrics included the Accreditation Council for Graduate Medical Education, Alliance of Independent Academic Medical Centers, American Association of Colleges of Osteopathic Medicine, American Board of Internal Medicine, American Board of Internal Medicine Foundation, American Board of Medical Specialties, American Board of Obstetrics and Gynecology, American Board of Physical Medicine and Rehabilitation, American Osteopathic Association, The Arnold P. Gold Foundation, Association for Hospital Medical Education, Foundation for Advancement of International Medical Education and Research, The Josiah Macy Jr. Foundation, National Board of Medical Examiners, and the U.S. Department of Veterans Affairs (Office of Academic Affairs).
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Contents
OPENING REMARKS: OPTIMIZING GME BY MEASURING OUTCOMES
Why Measure GME Outcomes, and What Is Needed?
Discussion of Challenges to Identifying, Measuring, and Achieving Optimal Outcomes
CURRENT METRICS: WHAT IS MEASURED NOW?
National Board of Medical Examiners (NBME) Measurements
ACGME Milestone Data Measurements
GME Program Metrics of the Health Resources & Services Administration
Metrics of the American Board of Medical Specialties
Lessons from Measuring Provider Performance in Clinical Practice
National-, Regional-, or State-Level Metrics
CAN OUTCOME MEASUREMENT PROVIDE A PATH TOWARD EVIDENCE-BASED EDUCATION?
Answering GME Questions Using “Big Data” at New York University
Outcomes-Based Education in Surgery
Workforce Data and Metrics Based on Residency Program Outputs
Implications of Workforce Goals
Alignment Between GME Goals and Public Policy Priorities
Lessons Learned from State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education
Achieving Buy-In and Requiring Data Reporting
How Should a National Database Be Maintained and Funded?
Boxes and Figures
BOXES
3 Summary of Outcome Metrics Discussed by Workshop Breakout Groups
FIGURES
2 The medical education data continuum
3 NYU Langone’s approach to merging and analyzing data sets to assess medical education
4 Education to outcomes and value in surgery
5 A framework for the assessment of graduate medical education
6 Projected adult population under two different scenarios, 2015–2030
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