The Ethos of Medicine in Postmodern America by Eiser Arnold R.;

Author:Eiser, Arnold R.;
Language: eng
Format: epub
Tags: undefined
Publisher: Lexington Books
Published: 2012-08-15T00:00:00+00:00

ACGME and Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME) is the main accrediting agency for graduate medical education in the United States and thus plays a crucial role in the formation of new practicing physicians in the USA. Simply put if a residency is not certified by the ACGME (or in the case of osteopathic residencies by the American Osteopathic Association), the Centers for Medicare and Medicaid Services (CMS) will not fund the residency training program, while state licensure boards and hospital staffs may not credit the training experience and credential the physician as an attending physician. So these organizations exert very substantial control of physician training in the United States.

The ACGME in conjunction with the American Board of Medical Specialties (ABMS) implemented a system of six core competencies: medical knowledge; medical care; medical professionalism; systems based practice; practice based learning; and patient-physician communications. (I had the opportunity and privilege to consult to the American Board of Medical Specialties on the matter of assessing medical professionalism, and to work with ACGME staff on this matter.)[27] Professionalism is the competency most relevant to the current discussion. The ACGME defines professionalism as: compassion; integrity; demonstrating respect for others; placing patients’ needs above self interest; respect for patient autonomy and privacy; accountability to patients, society, and the profession; and sensitivity to diversity with regard to gender, age, culture, religion, race, disabilities, and sexual orientation.[28]

With professionalism so broadly and explicitly defined it encompasses cognitive skills as well as personal traits and qualities. The cognitive skills include knowledge about respecting patient autonomy, the fundamental principle of American bioethics, and how to address issues demonstrating respect for the multitude of minority perspectives. The personal traits invoked in this definition comprise compassion, honesty, altruism, and reliability, qualities that are not necessarily part of the medical school selection process nor are they likely to be precisely measured. This wide breadth of the scope of medical professionalism makes it profoundly challenging to foster its development in a group of individuals but especially those reared in a postmodern culture of materialism and personal indulgence.

Huddle takes the ACGME to task for considering professionalism a skill like any other.[29] This author observes that moral norms develop in childhood before higher education occurs. So is it too late to learn professionalism in medical school and residency training? Some of the desirable professionalism traits may begin in childhood but the question is how well are they sustained through the period of young adulthood and the extended period of medical training.

From the social psychology literature, moral development develops primarily in childhood and adolescence and, to a lesser extent, in the early twenties.[30] Huddle points out that the environment in graduate medical education is not an all-encompassing value-laden environment such as a convent or Marine boot camp that is emotionally intense enough to reshape moral traits of character. Thus medical schools do not, nor can they, select for moral traits. In addition, they do not exert a great deal of effectiveness at instilling them in the third decade of life.

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