Shortcomings in health care outcomes have prompted calls for continued reform in medical education.^1,2 The American Medical Association (AMA) Accelerating Change in Medical Education initiative has supported innovators in graduate medical education (GME) through the Reimagining Residency (RR) initiative.^3,4 The 5-year, $20 million RR initiative funded 11 projects after receiving 252 letters of intent. The main focus areas of the RR projects have been competency-based medical education, transitions, the learning environment, health systems science, and workforce (Figure).

Figure Projects Sponsored by the American Medical Association Reimagining Residency Program
Citation: Journal of Graduate Medical Education 17, 2s; 10.4300/JGME-D-24-00367.1

Systems-Based Practice and Health Systems Science in Graduate Medical Education: Recommendations for Embracing This Critical Core Competency

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Introduction

Program evaluation is a crucial component of graduate medical education (GME), as it systematically assesses educational interventions through standardized methods, feeding data back to programs for evidence-based improvements to advance training in high-quality, patient-centered care. Without this rigorous analytic approach, we cannot know how, when, and why interventions affect learning, care quality, and patient health outcomes. Program evaluation requires specialized skills and training¹ that educators and administrators may not possess, and for which institutional resources may be lacking. This gap hinders evidence-driven change in GME.

Educational innovations require iterative evaluation cycles for continuous quality improvement. Perspectives of

ABSTRACT

Background As graduate medical education programs implement competency-based medical education (CBME) approaches, many specialties struggle to adopt this paradigm in a way that successfully incorporates the 5 core components of CBME.

Objective To develop and implement the 5 core components of CBME within 8 US emergency medicine (EM) residency programs and assess acceptability and feasibility.

Methods We designed an intervention to implement the 5 core components of CBME: (1) an outcomes framework; (2) developmental progression; (3) tailored learning experiences; (4) competency-focused instruction or coaching; and (5) programmatic assessment. A consensus process to develop the framework and developmental trajectory was followed and included the development and deployment of programmatic assessment, coaching programs, and individualized learning plans using a shared model for implementation. We implemented the intervention beginning in August 2021. We surveyed site implementation leads about its feasibility and acceptability.

Results The survey response rate was 100% (8 of 8). Estimated time required for the project intervention was 2 to 15 hours per month and 4 to 21.4 hours per month for the program coordinator and program leadership, respectively, with no additional salary provided. Residents and faculty received brief training about the CBME program (0.25 to 1 hours for residents and 0.5 to 1 hour for faculty), with periodic reminders afterward. Site leads perceived mixed acceptability from residents and faculty. Perceived challenges to implementation included resistance to change, time limitations, faculty discomfort with providing written assessment data, and difficulties navigating institutional barriers to technology-enhanced data collection.

Conclusions CBME was estimated to require manageable time for program staff and leadership, with mixed acceptability from residents and faculty.

ABSTRACT

Background Promotion in Place (PIP) is a competency-based time-variable graduate medical education innovation model developed at Mass General Brigham and not previously tested for feasibility, acceptability, or outcomes.

Objective To assess early PIP outcomes in the Massachusetts General Hospital (MGH) pathology residency program.

Methods Approved by the American Board of Pathology, PIP was launched in 2021. The Clinical Competency Committee developed and implemented explicit graduation criteria. Trainees meeting criteria who chose early graduation became credentialed, board-eligible junior attendings at MGH in a period of “sheltered independence” and were assessed using the Focused Professional Practice Evaluation. PIP sheltered independence (PIP-SI) participation rates, time, and activities were followed. We also assessed board pass rates, Milestones, and patient safety reports for all residents. We measured additional participant time and resources.

Results Over 4 years, 24 of 30 (80%) residents qualified for PIP-SI, 17 of 24 (71%) accepted, and 7 of 24 (29%) declined. Eleven of 17 (65%) had a period of sheltered independence as junior attendings (median 9 weeks [range 5-24 weeks]) in various anatomic and clinical pathology roles. Of 6 eligible residents not participating, 4 took a leave of absence, and 2 experienced licensing or visa delays. All residents passed their board examinations on the initial attempt and none had concerns identified through patient safety reports. Time and resource requirements were acceptable to stakeholders.

Conclusions Most residents met criteria for PIP-SI and accepted, demonstrating high acceptability. PIP-SI was feasible with implementation into standard workflows over 4 years. PIP-SI attendings had no adverse outcomes identified.

Welcome to the JGME Reimagining Residency Supplement

Reimagining Residency: An Initiative to Transform GME Through Collaborative Innovation

Large Language Model–Augmented Strategic Analysis of Innovation Projects in Graduate Medical Education

Coaching in GME: Lessons Learned From 3 Unique Coaching Programs

Improving the Transition From Medical School to Residency in Obstetrics and Gynecology: Lessons Learned and Future Directions

Background

Training More Physicians for Medically Underserved Communities: The Power of Regional Medical Education Collaboratives Across the Training Continuum

Introduction

Integration of Interprofessional Education Into Routine Resident Practice: 2 Cases of Successful Implementation

Introduction

Seven Tips for Successfully Operationalizing GME Innovations at the System Level: The iPACE Experience

Avoiding the Storm: Recommended Practices for Building Cross-Institutional Teams and Collaboration in Graduate Medical Education

How Data Analytics Can Be Leveraged to Enhance Graduate Clinical Skills Education

Change Management and Innovation in Graduate Medical Education

Systems-Based Practice and Health Systems Science in Graduate Medical Education: Recommendations for Embracing This Critical Core Competency

Introduction

Program Evaluation for Graduate Medical Education: Practical Approaches From the Reimagining Residency Evaluation Community of Practice

Introduction

Implementing the 5 Core Components of Competency-Based Medical Education in US Emergency Medicine Residency Programs

ABSTRACT

Implementing the Promotion in Place Model of Competency-Based Time-Variable Graduate Medical Education in Pathology

ABSTRACT

Lessons From Reimagining Residency and the Future of Innovation in Graduate Medical Education

Innovation in GME

Rouge on the Lips of Silence

Evaluating Methodology for Increasing Diversity in US Residency Training Programs: A Scoping Review

Scoping Review of Simulation-Based Training for Social Determinants of Health Within Residency Programs

Career Outcomes Among Graduates of 2 Urban Health Primary Care Training Programs

Trends in MedEdPORTAL Faculty Development Resources for Clinician Educators

The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study

A Values Affirmation Intervention to Improve Female Residents' Surgical Performance

Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule

Skills for Interviewing Adolescent Patients: Sustainability of Structured Feedback in Undergraduate Education on Performance in Residency