The current system rates a “C” in terms of its proficiency in training physicians, said Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education. Standards on accreditation for these programs have primarily been driven by what happens in the field first, he said. Residents are accumulating medical knowledge instead of specific skills.

Nasca’s hope is that over the next five years accredited residency and fellowship programs will move toward a more proactive, innovative approach, where curricula will be driven by clinical-outcome measures, he said. An external accountability system for those outcomes should be developed to produce more-competent physicians, he said.

Surveys have shown that residents completing training and doctors entering the field don’t feel adequately prepared to care for common medical conditions—a situation that’s being aggravated in part by the growing number of chronically ill patients, said Michael Whitcomb, former senior vice president of medical education for the Association of American Medical Colleges.

At least part of Medicare’s graduate medical education payments could be contingent on developing training programs that place residents in environments that foster high-performance inpatient and outpatient care, suggested Benjamin Chu, president of Kaiser Permanente’s Southern California region.

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