#ACGME2024 Day 3 Recap

March 11, 2024

Two informative plenaries bookended the third and final day of the 2024 ACGME Annual Educational Conference. Educational sessions continued throughout the day, and then the conference concluded with the annual “Toast on the Terrace” reception.

Morning educational sessions covered a range of important and topical areas. In “Approaches to Reducing Stigma and Barriers to Mental Health,” program directors, coordinators, and others charged with improving well-being for the graduate medical education (GME) community shared evidence-based interventions that worked in their programs in the hope that others could also implement them locally. During “Innovative Projects to Get Residents/Fellows Back to Bedside: A “Shark Tank” Competition,” six Back to Bedside teams from the current cohort of funded projects pitched a team of “sharks.” It was a fun, inspiring, and high-energy way to kick off the last day of the conference. The ACGME is currently seeking proposals for a fourth round of Back to Bedside funding; the deadline to apply is April 22, 2024.

Improving the Culture of Residency
This year’s Marvin R. Dunn Keynote Address, moderated by ACGME Associate Chief Accreditation Officer Mary E. Klingensmith, MD, spotlighted a series of national cluster-randomized trials in surgery conducted over the last several years to address important issues in GME. Speakers Karl Y. Bilimoria, MD, MS and Yue-Yung Hu, MD, MPH shared findings from the trials and provided attendees with actionable steps to help improve the culture in their programs and institutions.

Through a partnership among the ACGME, the American College of Surgeons, the American Board of Surgery, and the Surgical Outcomes and Quality Improvement Center at Indiana University School of Medicine, the initial trial—the “FIRST Trial”—focused on bringing high-level evidence to the issue of clinical work and education hour policies. The findings led to changes in the ACGME’s clinical work and education hour requirements, as well as spurred the subsequent “SECOND Trial,” which sought to reduce resident burnout and mistreatment. Recently concluded, the experience from the SECOND Trial suggests programs are struggling with building inclusive environments, so the forthcoming “THIRD Trial” will investigate ways to improve diversity, equity, and inclusion in surgical departments.

Dr. Bilimoria presented the results of the FIRST trial, which compared a rigid set of clinical work and education standards to a more flexible approach; both approaches capped hours worked per week at 80. Results showed that surgical residents were either in favor of or neutral to the more flexible structure. “Certainly, we made continuity of care better with flexible [clinical work and education] hours,” he said.

But the study also revealed that 39 percent of general surgery residents were experiencing burnout that was caused by factors other than hours worked. This finding led to the creation of the SECOND Trial, focusing on burnout and mistreatment. This trial concluded in June.

Dr. Hu shared examples of burnout interventions that worked and of those that did not and said study authors encouraged participating programs to share their data with the residents and faculty members to build trust through transparency.

“Residents know [the data] because they’re the ones that made it look that way… Burying it fails to acknowledge the issues that are there,” Hu said.

The pair closed the session encouraging surgical programs to sign up for the THIRD Trial.

Conversations with the CEO
In an emotional and uplifting final session of the conference, ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP conducted his last “Conversations with the CEO” Q and A session with the GME community. During his introductory remarks, ACGME Chief of Staff and Chief Education Officer Timothy P. Brigham, MDiv, MS, PhD’s spoke of how it took a year for Dr. Nasca to convince him to join him at the ACGME 17 years ago. What finally sealed Dr. Brigham’s decision?

“He brought me to a conference here to meet all of you,” Dr. Brigham said, his voice tightening with emotion. “There are eight billion people in the world. There’s only one person I would have followed to do this. And that person is Thomas Nasca.”

Dr. Nasca fielded questions ranging from GME finances to the future of the profession, to the evolving roles of the program directors and coordinators. He answered each with honesty, optimism, and a call for everyone to join in the work of making medical education—and therefore health care in the US and beyond—more patient-centered and compassionate, one resident or fellow at a time.

When asked about reducing administrative burden on mid-sized and large Sponsoring Institutions during the Annual Update, Dr. Nasca invited the community to help find solutions, but noted that the ACGME has “a responsibility to collect information from you and make decisions,” noting that it is a core element of a profession “to agree to be monitored by your peers.”

He also acknowledged the evolving role of coordinators in GME, while drawing a boundary between the ACGME’s and an individual institution’s roles. The ACGME does not and cannot classify job roles in any institutions, “but what we can do is define the capabilities and the responsibilities as standards” that can then be used by coordinators to lobby for job reclassifications. The Common Program Requirements will come up for review in 2025, which will give the GME community opportunities to explore and request such changes, he said.

A common thread in his answers was Dr. Nasca’s underpinning belief that to achieve true excellence as a physician, technical and clinical skill is not enough. “Altruism, compassion, a willingness to commit to a life of learning, to submit to peer evaluation, those are the elements of professionalism that must exist,” he said.

As for his legacy, Dr. Nasca replied with humility. “I want to be remembered for doing the right thing for the right reason even when it was not in my own best interest.”

After the questions ended, ACGME Board of Directors Chair Claudia Wyatt-Johnson, MA and Chair-Elect George E. Thibault, MD announced two surprises that will create a living legacy Dr. Nasca at the ACGME. The Thomas J. Nasca, MD Professionalism Award, which will undergo development via the Awards Committee of the Board, will be awarded for the first time in 2025. Additionally, moving forward and beginning next year, the final session of the ACGME Annual Educational Conference will be named the Thomas J. Nasca Lecture.

Save the Date for #ACGME2025
The emotional conclusion of the conference’s educational content transitioned smoothly into a celebratory toast. As attendees and ACGME staff members and leaders return to their own programs, institutions, and home offices, the lessons learned and connections built at the 2024 Annual Educational Conference will most certainly fuel change, innovation, and evolution in both the short- and long-term future of GME.

The ACGME thanks all who contributed to, supported, and attended the conference. We hope to see you all next year at the 2025 Annual Educational Conference, scheduled for February 20-22 at the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee. Stay tuned on the ACGME website for the opening of the Calls for Sessions, Abstracts, and Exhibits/Sponsors – all coming soon!