Graduate medical education at the Medical College of Wisconsin: new initiatives to respond to the changing residency training environment.

Nationally, Graduate Medical Education (GME) is facing a series of challenges. These include cutbacks in Medicare funding, major changes in accreditation standards requiring education in and assessment of "general (core) competencies," and reduction in housestaff work hours. GME at the Medical College of Wisconsin (MCW) is managed by a consortium called the Medical College of Wisconsin Affiliated Hospitals, Inc. (MCWAH), which is comprised of 13 health care institutions in Southeastern Wisconsin. The general competencies required by the Accreditation Council for Graduate Medical Education (ACGME) include six focal areas: (1) patient care; (2) medical knowledge; (3) professionalism; (4) interpersonal and communication skills; (5) practice-based learning and improvement; and (6) systems-based practice. Traditionally, the GME programs have focused on training and assessment specific to patient care and medical knowledge, but have limited emphasis on the other four. To address this gap, MCWAH has launched several initiatives to enhance teaching and assessment of the other four competencies. An on-line residency management system marketed by New Innovations of Toledo, Ohio is being used to provide a web-based residency management system, allowing the faculty and residents to evaluate one another at the end of each rotation. Faculty development programs for residency program directors have been initiated to ensure they have the knowledge and skills associated with teaching and assessing the core competencies. We are now piloting a 360-degree evaluation system to include evaluations of residents and faculty by co-workers and patients. The ACGME is in the process of mandating reduced duty hours for the housestaff. As a result, residents will have less time for direct patient care responsibilities with more intensive use of other education and training strategies to ensure that they become independent specialists. GME is undergoing a major paradigm change, and MCWAH remains on the cutting edge in responding to the challenges.