The Impact Of Managed Care On Internal Medicine Graduate Medical Education At Brooke Army Medical Center

Brooke Army Medical Center (BAMC) is a 450-bed tertiary care hospital with a multi-fold mission to provide comprehensive patient care, medical education, and research. The implementation of managed care has caused BAMC's focus to shift from an academic role to a primary care role, with increased emphasis on productivity and cost-effectiveness. Successfully balancing managed care programs and graduate medical education (GME) programs has been especially challenging because managed care goals are often inconsistent with the traditional goals of a specialty driven, academic teaching institution. This project studied data on BAMC's Internal Medicine Residency Program (1993 - 1999) to identify changes attributable to implementation of managed care. Results showed both positive and negative impacts. It has increased the staff's focus on prevention and on their responsibility to provide a continuum of care to enrolled beneficiaries. This has had a positive influence on the procedure workload for internal medicine because it is a primary care service. However, research and workload data indicate that the environment for training and education is becoming more constrained.

Graduate medical education (GME) continues its decades-long evolution. Evidence-based approaches are increasingly transforming the way we educate, evaluate, and promote GME trainees. Key to this transformation is our ability to recognize that “medical education” constitutes a true lifelong continuum, beginning with pre-medical education, then proceeding to medical school, residency (and potentially subsequent fellowship) training, and then finally the so-called maintenance of certification that continues throughout one’s entire professional career. This book explores a broad range of important topics, including the novel concept of “coping intelligence,” the important role of “work-life integration,” professional coaching and mentorship, professional development and career-long learning, patient-provider relationship, the impact of the COVID-19 pandemic on medical education, as well as the introduction of modern technologies to ameliorate the effects of social distancing. The book further discusses two important aspects of GME program management: the process of establishing new GME programs as well as the highly intricate process of merging residency programs. Different aspects and perspectives are incorporated, including those of residents, faculty, and program leadership. The book ends with chapters on diversity, equity and inclusion, and the importance of community-based medical education.

Graduate medical education (GME) is critical to the career development of individual physicians, to the functioning of many teaching institutions, and to the production of our physician workforce. However, recent reports have called for substantial reform of GME. The current lack of established GME outcome measures limits our ability to assess the impact of individual graduates, the performance of residency programs and teaching institutions, and the collective contribution of GME graduates to the physician workforce. To examine the opportunities and challenges in measuring and assessing GME outcomes, the National Academies of Sciences, Engineering, and Medicine held a workshop on October 10â€"11, 2017, in Washington, DC. Workshop participants discussed: meaningful and measurable outcomes of GME; possible metrics that could be used to track these GME outcomes; possible mechanisms for collecting, collating, analyzing, and reporting these data; and further work to accomplish this ambitious goal. This publication summarizes the presentations and discussions from the workshop.