Volume 16: Issue 6

Non-Teaching Service Versus the Non-Teaching Patient

The Accreditation Council for Graduate Medical Education (ACGME) surveys residents annually to ensure that the clinical learning environment, resident education, and resident experiences meet expectations of the Common Program Requirements. Under the category of Clinical Experience and Education, one of the questions on the internal medicine Resident/Fellow Survey asks, “Do you routinely provide care for patients on the non-teaching service?”¹ Our program received the following comment: “…in the internal medicine section of the resident survey, residents are routinely seeing non-teaching patients.”

This report provoked thoughts about the interpretation of non-teaching service vs

Thomas J. Nasca, MD, MACP, served as the President and Chief Executive Officer (CEO) of the Accreditation Council for Graduate Medical Education (ACGME) for 17 years, with his tenure ending December 2024. During this time he led and supported significant changes in accreditation and medical education. This article will examine the changes during this period through the lens of key themes, including the redesign of the graduate medical education (GME) accreditation model and new and expanded roles that the ACGME assumed during 3 phases between 2007 and 2024: (1) the development years leading to the Next Accreditation System (NAS), (2) implementation of the NAS, and (3) the COVID-19 pandemic.

Launched in 2012, the NAS redesigned accreditation as a balanced combination of assurance- and improvement-focused policies and activities. The NAS served as the foundation for harmonizing GME training through the creation of the single accreditation system. The ACGME also took on new roles within the professional self-regulatory system by tackling difficult issues such as wellness and physician suicide, as well as diversity, equity, and inclusion in medical education. In addition, the ACGME substantially expanded its role as facilitator and educator via the introduction of multiple resources to support GME. However, the medical education landscape remains complex and faces continued uncertainty, especially as it emerges from the effects of the COVID-19 pandemic. The next ACGME President and CEO faces critical issues in GME.

Background Although Clinical Competency Committees (CCCs) were implemented to facilitate the goals of competency-based medical education, implementation has been variable, and we do not know if and how these committees affected programs and assessment in graduate medical education (GME).

Objective To explore the roles CCCs fulfill in GME and their effect on trainees, faculty, and programs.

Methods We conducted a narrative review of CCC primary research with the following inclusion criteria: all articles must be research in nature, focused on GME and specifically studying CCCs, and published in English language journals from January 2013 to November 2022.

Results The main results are as follows: (1) The primary role of the CCC (decision-making on trainee progress) is mostly described in “snapshots” (ie, focusing on a single aspect of this role at a single point in time); (2) CCCs are taking on secondary roles, some of which were anticipated (eg, remediation, feedback) whereas others were “unanticipated” (eg, use of CCC data to validate trainee self-assessment, predict trainee performance in other settings such as certifying examinations, investigate gender bias in assessment); and (3) Articles briefly mentioned short-term outcomes of CCCs at the level of the trainees, faculty, and programs. However, most studies described interventions to aid CCC work and did not specifically aim at investigating short-term (eg, curriculum changes) or long-term outcomes (eg, improved patient outcomes).

Conclusions CCCs fulfill a range of roles in assessment beyond their intended purpose. A more systematic approach is needed to investigate the outcomes of CCC implementation on GME.

Background Gossip is a ubiquitous sociocultural phenomenon serving many functions in human interactions, including in workplace and academic settings. Gossip can have profound positive and negative impacts; however, its impact on medical residents and their learning environment is unknown.

Objective To understand the function and impact of workplace gossip—from and about colleagues and supervisors—on medical residents’ experiences in their learning environment.

Methods This exploratory study used principles of constructivist grounded theory. Data were collected from residents in the obstetrics and gynecology and psychiatry programs at a large academic institution via semistructured interviews in 2021. Seven residents were interviewed. Transcripts were analyzed using inductive coding, and themes were identified.

Results Thematic analysis revealed perceived positive and negative impacts of gossip. Perceived positive impacts included affirmation and roadmapping. Perceived negative impacts included anxiety/fear and the role of gossip in reinforcing the educational hierarchy. Other themes, which are perceived to have both positive and negative impacts, included the role of gossip in learning and in group status. The identity of the gossiper, audience, and subject of gossip also impacted its effects. Gossip between residents about faculty members was perceived as roadmapping, or an affirming role, whereas gossip involving faculty members created anxiety and reinforced negative aspects of the hierarchy.

Conclusions Workplace gossip serves both positive and negative roles within the medical learning environment. It can function as informal debriefing and can also threaten psychological safety. Its impact on residents is affected by the identities of the gossiper, subject, and audience.