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GILBERT ET AL
tional scholars, leaders, researchers, and/or service providers. 5
The establishment of a successful faculty development program
can facilitate educational change and improvements in the academic
medical environment. 8 Within the United States and
abroad, many institutions established professional development
programs decades ago to improve their educational missions
with demonstrated success. 6-19 Nationally, professional organizations
such as the Accreditation Council for Graduate Medical
Education (ACGME) have modifıed how we evaluate and promote
trainees to best support the evolving societal expectations
of the modern physician. 20 Thus, change has brought new opportunity
to medical education and laid the foundation for a
utopia of sorts within this arena. Although this seems like a tall
order, this goal can be achieved through innovative medical education
programing, and we now enter a renaissance period in
medical education to support this end product. We are already
seeing the early influence of this new movement on both a national
and an institutional level. 5,21,22 Educators have a responsibility
to train the present and next generation to carry the
torch, not only to service a new generation of learners, but also to
create an innovative army of educators to maintain and, ultimately,
build on the momentum of educator creativity and productivity.
Let’s return to the original question, what would Tinsley Harrison
do? In his book, Tinsley Harrison, MD: Teacher of Medicine,
James Pittman notes: “He (Harrison) died a bitter critic of
the mindless overuse of the medical technology he himself had
helped develop and of what he considered the disoriented nature
of universities and their even more disoriented medical
schools.” 1 Although Harrison might have been skeptical about
some aspects of the modern health care landscape, one would
suspect he would stand behind a movement that upholds medical
education as a platform to enact monumental change in
health care delivery with the ultimate goal of optimizing patient
care.
PRINCIPLES OF LEADERSHIP EDUCATION AND
DEVELOPMENT FOR MEDICAL EDUCATORS
George E. Thibault of Harvard Medical School noted, “curricula
were developed fırst, and then students were taught
and assessed. Now, curricula should be designed last, after
public health needs are assessed, and they should include innovations
such as interprofessional and interdisciplinary
training, new models of clinical education, new content to
complement the biologic sciences, competency-based and
individualized education tracks to speed the training process,
and incorporation of new educational technologies.” 23 A
changing health care landscape supports reform in medical
education. To meet the learner “right where they are” regarding
today’s health care system needs, teachers must modify
how they teach.
New challenges within health care systems and population
health imply a need for faculty development of the medical
educator to meet these new challenges. Additionally, professional
organizations such as the ACGME have adopted new
accreditation and evaluation systems to ensure graduating
physicians can support and promote the new demands of our
nation’s health care needs. Specifıcally, physicians are no longer
expected to function as independent actors but to function
as leaders and participants in team-oriented care. 4,20
Patients, payers, and the public demand their providers are
technologically adept, practice proactive evidence-based
medicine with cost containment, include the patient in their
decisions, and utilize health information technology to improve
care for individuals and populations. 4,20 To meet these
demands, the ACGME has produced the Next Accreditation
System (NAS), which educators now need to develop mastery
over and to develop novel programming to support others.
Developing such programs is not without potential challenges,
but the potential rewards remain substantial on a
personal, institutional, and national medical landscape perspective.
24 Table 1 demonstrates potential challenges and
wins in terms of medical educator development and community
outcomes. In truth, the challenge becomes not how we
can afford to invest in such programming but rather how can
we afford not to? Educational standards cannot afford to lag
behind delivery-system change. Investments in innovative
programming and development of the new medical educator
are required to meet this challenge.
THE EVOLUTION OF TEACHING AND ASSESSMENT
STRATEGIES
External forces affecting change in medical education include
the social contract that requires a better assessment
method to judge the competence of physicians before entering
practice in the modern health care environment. The
ACGME has developed the NAS to begin to meet this need.
The NAS now requires all medical training programs to
use competency-based milestone assessments. Previously,
trainees were evaluated on broader core competencies that
included patient care, medical knowledge, interpersonal
and communication skills, professionalism, practice-based
learning, and improvement and systems-based practice. 25
Faculty did not always receive training and may not have understood
these terms; making honest, concrete evaluations of
observable trainee progress and competence diffıcult, often
resulting in inflation of skills and knowledge levels. In contrast,
the NAS focuses on outcomes-based milestones for
trainee performance within these aforementioned six domains
of clinical competence. An example of such a milestone
that fulfılls the new social contract is: “Responds to
each patient’s unique characteristics and needs.” The clinical
competencies that this milestone speaks to are professionalism
and interpersonal communication skills. Although this
might seem like another esoteric description, the milestone
itself is broken down into key observable behaviors “as determined
by individual programs.” For example, observable behaviors
that may inform this milestone include: the trainee
discussing end-of-life issues with a patient of a different cul-
34 2015 ASCO EDUCATIONAL BOOK | asco.org/edbook