Transitions in Training

I recently sat down to dinner with a couple of medical residents from NYC area training programs and I was struck by the range of topics that came up in the conversation.  Beyond the clinical topics, which would have dominated the discussion during my decades-earlier residency days, we chatted about resident-led quality improvement studies, medication reconciliation initiatives, interactions with health informatics colleagues, and transitions of care programs.  It was exciting to see that these themes were clearly entrenched in the mindset of my dinner companions; they recognized that expertise in these areas was critical in achieving their career goals.

Of course, efforts to evolve training programs to increase emphasis on the skills necessary to actively contribute to health system improvement are only in their early stages.  William Warning, MD, CMM, FAAFP, Program Director of the Crozer-Keystone Family Medicine Residency Program based in Springfield, PA, provided great insights on this topic in a recent interview published in the May issue of Medical Home News.  Dr. Warner is co-chair of the Education and Training Task Force for the Patient-Centered Primary Care Collaborative (PCPCC), a role that keeps him deeply involved in efforts to develop a work-force optimally trained to deliver “patient-centered, team-based, integrated, and collaborative primary health care”.   He described efforts in his program to incorporate leadership training in change management and team skills, inter-professionalism, and care coordination skills. He is encouraged by early results from Crozer-Keystone as well as other model programs, but acknowledges in the interview that “we have a ways to go.”

The Accreditation Council for Graduate Medical Education (ACGME) is currently conducting clinical site visits to learn about how programs are supporting training in six focus areas of patient safety, quality improvement (including health care disparities), transitions in care, supervision policies, duty hours and fatigue management, and professionalism through the Clinical Learning Environment Review (CLER) program.  A key goal of the CLER program is to contribute to the process of preparing the next generation of US physicians by optimizing the graduate medical education learning environment to “deliver both high-quality physicians and higher quality, safer, patient care”. (

We’re excited about the role educational technology can play in these efforts, from enhancing medical school curricula, designing and assessing innovative learning experiences for residents and fellows, encouraging collaboration, and disseminating best practices. Strong educational technology platforms can make an important contribution in providing operational efficiency and scalability for the model initiatives that will collectively prepare health professionals for leadership roles in our increasingly complex, value-based healthcare system.