Adapting Graduate Medical Education (GME) to 21st Century Healthcare

The U.S. healthcare system is at a critical juncture, undergoing significant change in several respects, including:

  • Consolidation of both healthcare providers and healthcare payers
  • Relocation of a substantial portion of care from centralized hospital settings to decentralized ambulatory care settings
  • The integration of artificial intelligence and “big data” into mainstream medical practice
  • A shift in care management from individual practitioners to interprofessional and interdisciplinary care teams
  • A shift of financial risk from payers to providers through hybrid payment systems that increasingly emphasize pay for performance and population health.

Cognizant of the rapid evolution of the healthcare system as a whole, AAHC conducted a series of Regional GME Roundtables to identify broad areas of concern with the operation and output of the current GME system. It was clear from the Roundtable discussions that the current GME system needs to adapt to a forward-looking 21st century graduate medical education system.

Despite the best efforts of those who organize and run GME programs, the GME system is facing several critical structural issues, including:

  • There is a mismatch between the output of GME programs and local/regional workforce needs
  • The hospital-centric GME system needs to improve training of health professionals for the environments in which they will actually practice
  • The current system must address the stress and mental health issues associated with residency training

As they transform the education mission, academic health centers should consider how a market-based response to these structural shortcomings could be organized.


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