Complexities of Physician Workforce Projection: Call for a Unified National Healthcare Workforce Policy.

Ensuring an adequate supply of physicians is paramount in securing the future of healthcare. To do so, accurate physician workforce predictions are needed to inform policymakers. However, the United States lacks such predictions from reliable sources. Several non-governmental organizations have actively been involved in attempting to quantify workforce needs, but they often employ opaque methodologies and are deeply conflicted, leading to potentially unreliable or biased results. Moreover, while federal and state entities invest approximately $15 billion annually in graduate medical education (GME) payments, they have very little control over how the funding is used to shape the future physician workforce. In this article, we review physician workforce predictions from both an international and a domestic perspective and finally discuss how the creation of an apolitical, data-driven, expert-led panel at the federal level with sufficient authority to influence broader workforce policy is the optimal solution for ensuring an adequate supply of physicians for generations to come.

Do Resident Unions Improve Graduate Medical Education Training? Benefits and Potential Pitfalls.

ABSTRACT: The last 10 years have seen an increase in union representation for residents and fellows across the United States. It is estimated that 15% of residents and fellows are represented by unions. With increasing numbers of U.S. residents and fellows in graduate medical education (GME) programs being represented by unions, the authors contend that it is worthwhile to consider the benefits and potential drawbacks of resident unions and how GME and health system leaders can best work to ensure that the educational needs of residents continue to be emphasized in an era of resident unionization. Union bargaining can be a method to secure salary increases and other benefits for residents. Unionization can also provide a mechanism for more rapidly addressing worker protection issues and allows residents to advocate on behalf of patients. Residents participating as union leaders may develop important leadership and negotiation skills as well as gain beneficial knowledge about health system structure, financing, and priorities. However, with all the possible benefits that may come with resident unionization, there are also potential pitfalls. The collective bargaining process may create an adversarial relationship between program and institution leaders and trainees. Additionally, while residents are considered employees and able to collectively bargain, the National Labor Relations Board has also acknowledged that residents are "students learning their chosen medical craft." Program and institution leaders have an obligation to prioritize resident education and adhere to accreditation requirements even when these requirements conflict with union demands. Furthermore, because of the obligation to protect the public, program leaders should maintain control of resident academic due process issues. Program and institutional leaders must continue to prioritize resident education. Furthermore, GME leaders have a joint responsibility to create clinical learning environments that are conducive to quality patient care and promote resident learning and well-being.

Engaging GME Learners in Health System-Aligned Improvement Work in the Clinical Learning Environment.

Alignment between graduate medical education (GME) and health system priorities is foundational to meaningful engagement of residents and fellows in systems improvement work within the clinical learning environment. The Residents and Fellows Leading Interprofessional Continuous Improvement Teams program at the University of California San Francisco was designed over a decade ago to address barriers to trainee participation in health system-based improvement work. The program provides structure and support for health system-aligned trainee-led improvement projects in the clinic learning environment. Project champions (residents/fellows) from GME programs attend workshops where they learn improvement methodologies and develop proposals for health system-based improvement projects for their training programs. Proposals are supported by local faculty mentors and are reviewed and approved by GME and health systems' leaders. During the academic year, teams share their progress using visual management boards and interactive leader rounds. The health system provides a modest financial incentive for successful projects. Since the program's inception, thousands of trainees from 58 residency and fellowship programs have participated either as champions or participants in the program at least once, and in total over 300 projects have been implemented. Approximately three-quarters of the specific improvement goals were met, all projects meaningfully engaged residents and fellows, and many projects continued after the learners graduated. This active partnership between GME and a health system created a symbiotic relationship; trainees received education and support to complete improvement projects, while the health system reaped additional benefits from the alignment and impact of the projects. This partnership continues to grow with steady increases in participating programs, spread to partner health systems, and scholarship for trainees and faculty.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams.

BACKGROUND: In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME. OBJECTIVE: To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams. METHODS: We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts. RESULTS: Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS. CONCLUSIONS: Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.

Jump-Starting Faculty Development in Quality Improvement and Patient Safety Education: A Team-Based Approach.

PROBLEM: Quality improvement (QI) and patient safety (PS) are cornerstones of health care delivery. Accreditation organizations increasingly require that learners engage in QIPS. For many faculty, these are new domains. Additional faculty development is needed for them to teach and mentor trainees. Existing programs, such as the Association of American Medical Colleges Teaching for Quality (Te4Q) program, target individual faculty and thus accommodate only limited participants at a time, which is problematic for institutions that need to train many faculty to support their learners. APPROACH: The authors invited diverse stakeholders from across the University of California, San Francisco (UCSF) School of Medicine and related health systems to participate in a team-based adaptation of the Te4Q program. The teams completed 5 projects based on previously identified priority areas to increase local capacity for QIPS teaching: (1) online modules for faculty new to QIPS, (2) a tool kit for graduate medical education programs, (3) a module for medical school clerkship directors, (4) guidelines for faculty to integrate early learners into QI projects, and (5) a "Teach-for-UCSF" certificate program in teaching QIPS. OUTCOMES: Thirty-five faculty members participated in the initial Te4Q workshop in January 2015, and by fall 2016, all projects were implemented. These projects led to additional faculty development initiatives and a rapidly expanding number of faculty across campus with expertise in teaching QIPS. NEXT STEPS: Further collaborations between faculty focused on QIPS in care delivery and those focused on QIPS education to promote QIPS teaching have resulted from these initial projects.

Observations on the 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions.

The 2016 World Congress on Continuing Professional Development: Advancing Learning and Care in the Health Professions took place in San Diego, California, March 17-19, 2016. Hosts were the Association for Hospital Medical Education (AHME), Alliance for Continuing Education in the Health Professionals (ACEhp), and Society for Academic Continuing Medical Education (SACME). The target audience was the international community working to improve medical (CME), nursing (CNE), pharmacy (CPE), and interprofessional (CIPE) continuing education (CE) and continuing professional development (CPD). Goals included: addressing patients' concerns and needs; advancing global medical and interprofessional health sciences education; utilizing learning to address health disparities; and promoting international cooperation. The five keynote speakers were: patient advocate Alicia Cole ("Why What We Do Matters: The Patients Voice"); linguist Lorelei Lingard ("Myths about Healthcare Teamwork and Their Implications for How We Understand Competence"); futurist and philosopher Alex Jadad ("What Do We Need to Protect at All Costs in the 21st Century?"); ethicist and change agent Zeke Emanuel ("Learn to Change: Teaching Toward a Shifting Healthcare Horizon"); and technology innovator Stephen Downes ("From Individual to Community: The Learning Is in the Doing"). Organizers announced the new Dave Davis Distinguished Award for Excellence in Mentorship in Continuing Professional Development to honor the career of David Davis, MD, in CME/CPD scholarship in Canada, the United States, and beyond. Participants valued the emphasis on interprofessional education and practice, the importance of integrating the patient voice, the effectiveness of flipped classroom methods, and the power of collective competency theories. Attendee-respondents encouraged Congress planners to continue to strive for a broad global audience and themes of international interest.