Finding Meaning in My Own Work: Attending My First ACGME Conference Part 1

Douglas Cassidy, MD

Resident in General Surgery at MGH

PGY 4

March 8, 2019 10:15 AM

Opening of the ACGME Conference 

The 2019 ACGME Conference in Orlando, Florida kicked off with a wonderful panel discussion led by Dr. Timothy Brigham featuring Dr. Victor Dzau of the National Academy of Medicine (NAM), Dr. Darrell Kirch of the Association of American Medical Colleges (AAMC), and ACGME’s Dr. Thomas Nasca about their own personal experiences with burnout and finding meaning in medicine. Dr. Kirch’s narrations of his struggles with burnout and depression as a medical student were especially inspiring as far too often physicians seem incapable of admitting to their own struggles, trying to portray an image of strength. As physicians, we are taught about the importance of empathy with regards to our patients; however, we often neglect to share this same empathy with our own colleagues in medicine. One of the most telling statistics of the discussion was that a higher proportion of physicians commit suicide compared to the number of opioid deaths in the general population. Not to dismiss the opioid crisis, but we must not ignore the struggle and issues we face within our own profession. Looking forward to a great conference with schedule sessions in general surgery as well as fostering and developing interprofessional relationships.

Discussion Panel featuring Drs. Brigham, Dzau, Kirch and Nasca

March 8, 2019 5:30 PM

I spent the first day of the conference attending surgery-specific sessions including a discussion of a national pilot program assessing the feasibility of entrustable professional activities (EPAs) in a general surgery residency. EPAs are made up of a group of milestones and are a framework for assessing competency in real world settings. For instance, in general surgery, and EPA might consist of management of benign biliary disease (see image). This EPA is made up of several milestones that demonstrate but are not limited to competency in knowledge, care of the patient, and intraoperative performance. The EPA bundles these milestones and subsequent competencies. Research has shown that there are growing concerns about the training gaps in residency for general surgeons and that an increasing number of graduates are not ready for independent practice at graduation. Although trainees are granted progressive responsibility, this is countered with diminished autonomy, especially with the influence of societal values and expectations.

This ongoing study touches on some of the struggles that face general surgery residencies, and likely all residency programs, with ongoing assessment. EPAs are meant to be frequent, directly observable, and based solely on the encounter or interaction being observed. The goal is to create a floor, rather than a ceiling, that allows for discrete credentialing in residency to allow graduated independent practice. In order to make frequent, observable assessments, there must be attending buy-in with regards to participation. There needs to be an easy and convenient way to provide assessment that is universal across residencies. With appropriate buy-in, EPAs would provide more meaningful assessments than the current graduation requirements of 6 clinical and operative evaluations. 

An example of an EPA in General Surgery for benign biliary disease