2014 Question of the Year

How can we ensure that our graduate medical education system will prepare trainees for practice in new systems of care delivery? Rapidly evolving health care systems will require that all caregivers have an expanded set of competencies beyond those fostered by our current educational programs. However, this year’s question focuses on graduate medical education because of its particularly critical role in the overall education of physicians. The evidence for delivery system change is all around us. Reform of the health care delivery system is being driven by increasing recognition that the growth in health care spending is unsustainable and that U.S. health outcomes lag behind those of many other nations, despite our high levels of spending. Glaring disparities of quality and access to care have eroded public confidence and fly in the face of our own professional values. Workforce models project future physician deficits. The need to improve health care value has emerged as a central theme and has focused attention on cost, quality, and access to care. How can our graduate medical education system prepare residents to successfully confront these issues? Care continues to shift from inpatient to ambulatory settings, increasingly delivered by interprofessional teams. Many individual practitioners are joining groups or becoming employed by hospitals, while health care systems are forming accountable care organizations and serving as medical homes. How can our graduate medical education system prepare residents for these new roles? Advanced health information systems facilitate measurement, reporting of new outcomes, and opportunities to improve patient safety. New technology will promote remote physicians’ consultations with patients and other physicians. And the much wider availability of health information is allowing patients to more actively participate in their health care decisions. How will our graduate medical education system help prepare residents to successfully manage these and other changes in technology? In responding to the 2014 Question of the Year, please note the following guidelines and instructions: We encourage responses from all members of health care teams and the academic medicine community as well as members of the public. We are particularly interested in the ideas of residents and residency program directors. An individual may be an author or coauthor of more than one response. To determine eligibility for authorship, please consult the journal’s “Complete Instructions for Authors” at http://journals.lww.com/academicmedicine/Pages/InstructionsforAuthors.aspx#authorship. Responses should have no more than four authors. The deadline for submitting responses to the 2014 Question of the Year is May 1, 2014. Responses should be essays with a maximum of 750 words, no more than three references, and no tables or figures. All essays must be written in English and submitted through the journal’s Web-based manuscript submission system (www.editorialmanager.com/acamed/). “Article Type” will be the first field on the submission form; please select the category “Response to 2014 Question of the Year.” If a submission is based on an existing program, it must be more than a program description or promotional piece. A program description can be used to support an argument, illustrate an underlying principle, or illuminate a new idea, but it is the argument, principle, or idea that will be of most value to readers. The journal’s professional editorial staff and editorial board will work with us to select essays to publish later this year. We will choose essays that present responses to the 2014 Question of the Year that are creative, imaginative, innovative, and feasible. We encourage you to let us know what changes you believe are needed in GME to produce a physician workforce that is better able to meet the nation’s needs. David P. Sklar, MD Editor-in-chief Debra Weinstein, MD Deputy editor Jan D. Carline, PhD Associate editor Steven J. Durning, MD, PhD Associate editor