We Are All Part of the Solution: A Call to Action from ACGME CEO Thomas J. Nasca, MD, MACP

March 3, 2018

All of you are a part of the solution… if there is anything we can do to help you individually or institutionally, we are here to help. I want to thank you for taking on the responsibility to make these cultural changes. It will make this change happen.”

More than 3,000 attendees gathered for the CEO Address at the Annual Educational Conference. The message was loud and clear: it’s time for us to collaborate and make change.

President and CEO Thomas J. Nasca, MD, MACP began by recognizing the medical community’s collective commitment to aspiring toward excellence. “Through collaboration along the medical continuum, we can transform our world. And we must,” he said.

He touched upon several major themes as both an update to the community and a call to action with a strong focus on the issue of physician and clinician well-being.

Dr. Nasca took the crowd through the ACGME's journey to understand the roots of resident suicide through research dating back to the 1920s. “This not a new problem,” he said. “And the problem is meaningful for patients too. We lose the capacity to care for thousands of patients with the loss of a physician.” He spoke about the impact on families and the residents and faculty members who try to heal after a loss.

He went beyond resident suicide to address how the ACGME and many others have been working to tackle the issues of clinical depression and burnout in caregivers, welcoming everyone in the room to be a part of the change.

As covered in our previous post about the ACGME and physician well-being, Dr. Nasca informed the audience about efforts dedicated to this very important issue, including the annual Physician Well-being Symposium, the National Academy of Medicine’s Action Collaborative, and the recent New England Journal of Medicine perspective piece, “To Care is Human,” focused on collectively confronting the clinician burnout crisis, to name a few.

He spoke of resiliency, but the need to have a supportive environment in place in order to thrive. He encouraged the community to share resources within their programs and institutions, in particular the American Foundation for Suicide Prevention’s (AFSP's) “After a Suicide: A Toolkit for Physician Residency/Fellowship Programs,” and the AFSP's and Mayo Clinic’s video “Make the Difference: Preventing Medical Trainee Suicide,” which he suggested playing at orientation in July and in January after the holidays. He also shared the ACGME’s new Tools and Resources web page with toolkits, educational videos, screenings, and more to help the graduate medical education community support their physicians in training.

He went on to share data about resident deaths, much of which was featured in a recent Academic Medicine article, and again called for support. “I don’t believe that we can completely eradicate suicide in residency, but I believe if we don’t try, we will never get as low as we can get,” he said. “So that has to be our goal, not to lose one. The article notes that the rate of suicide did not change over the 15 years studied, and is lower than that of the general population.

Closely aligned with the issue of well-being, Dr. Nasca also focused on diversity within the training environment, and the need to identify disparities.

He stated that we can control the clinical learning environment and that we need to look closely at what is going on in our environments. “Examine your culture for unconscious bias,” he said. We can all do better.”

He continued to address broader issues within health care, including the opioid crisis, emphasizing that everyone has a responsibility to fix the problem by appropriately training today’s residents because they will practice in the way they are trained.

Dr. Nasca also stayed close to home with updates on how the accreditation process continues to be a tool for change. He shared statistics, including the increase in osteopathic programs achieving ACGME accreditation through the current transition to a single GME accreditation system, and the increase in subspecialization. He spoke about the expansion of ACGME International, research and dialogue through the Journal of Graduate Medical Education, and the progress made in providing feedback through Milestones and the Clinical Learning Environment Review Program, among others.

A common thread throughout the address was Dr. Nasca’s fervent call to action: for the graduate medical education community to come together to facilitate positive change in the clinical learning environment. Change that will enhance resident well-being, education, and the ability to best serve America’s patients.

Paraphrasing automobile executive Lee Iacocca, he said, “Passing medicine along from one generation to the next is the highest honor and is the highest responsibility anyone could have.”