One Dozen Things
U.S. Graduate Medical Education
Overview
Graduate Medical Education (GME) programs are highly organized teaching and learning environments. Residency training programs and fellowships must be approved and accredited by the Accreditation Council for Graduate Medical Education (ACGME). This national organization sets strict requirements for what must be learned, the clinical experiences that must be made available, how many and what kinds of patients must be seen, and general working conditions, including amount of work hours. Underlying all the requirements for training programs are six core competencies:
- Patient Care
- Medical Knowledge
- Practice-based Learning and Improvement
- Interpersonal and Communication Skills
- Professionalism
- Systems-based Practice
Although physician residents and fellows in GME training programs have a great deal of responsibility and may even be licensed physicians, ultimate responsibility for patient care and safety rests with the attending physician. For this reason, attending physicians must always be kept informed of all patient care issues, and it must be recognized that they have final authority in directing patient care and management. As physicians advance through their training, attending physicians tend to give them more autonomy and responsibility for patient care. However, it is critical to communicate clearly and frequently with the attending physician, especially for the junior resident or fellow.
GME training programs are designed to be learning environments in which questions are expected and where the physician in training may be lacking in some knowledge relevant to the care of the patient. This is feasible only because of the redundancy and oversight built into the system. However, in such situations, it is mandatory that you be completely forthright in acknowledging a mistake or the lack of knowledge to the attending physician. Honest mistakes or deficiencies in knowledge or skill can always be appropriately addressed; conversely, hiding mistakes, blaming others, faking knowledge, or any form of dishonesty is always wrong and could lead to termination from the training program and could preclude medical licensure.
