Tony Klappa skimmed through patient records at his computer, verifying the patients’ prescriptions before calling up the pharmacy to place the prescription.
But medical residents following Klappa, a fifth-year resident at the University of Iowa Hospitals and Clinics, will have a different, more structured experience.
By July 2013, the national Accreditation Council of Graduate Medicine Education plans to implement the Next Accreditation System. The new process would mandate goal-based assessments to be updated every six months. The current system analyzes a resident’s experience every three to five years.
Mark Wilson, the UIHC director of Graduate Medical Education, said the new program initiates a much-needed evolution in hospital residency programs.
"Apprenticeship-style education [used at UIHC] is critically necessary, but it’s not efficient," he said about the current program. "It doesn’t necessarily provide the breadth of experience that students need in the 21st century."
UIHC officials pay more than $100,000 per year to keep residency programs accredited, Wilson said, though costs will likely increase after the new program is implemented.
The Next Accreditation System will judge residency programs in six areas: professionalism, patient care, communication skills, medical knowledge, practice-based learning and improvement, and systems-based practice.
John Nylen, the temporary media contact for the medical council, said the Next Accreditation System has a wide scope of changes.
"When looking for progress, we look for results, but we also look beyond that for a variety of data on improvement between each visit," he said. "We’re focusing more on outcomes of education, so we’ll be looking for more than just compliance with regulations. We’ll look at how well residents meet expectations and what kind of progress they’re making."
Nylen said some funding for the program administration and for a portion of residents’ salaries comes from Medicare and private payers, though the hospital must cover remaining costs. Council officials have not yet projected costs for the changes.
UIHC officials say they are willing to prioritize education.
"While some believe that the residents’ education will cost too much," Wilson said, "we have to be held accountable for education."
The accreditation council board of directors began developing the new program in 2005. Four years later, the council decided to structure residency programs around the six areas, which eventually became a part of the Next Accreditation System.
Pediatrics program director Stacy McConkey said the areas fit with individual programs to provide a better view of educational goals.
"The [areas] have given us things to look at," she said. "They help us evaluate residents more efficiently and define the expectations of the [areas] better."
One key aspect that residents look for in programs is experience, said UIHC chief resident Bashar Al Jayyousi.
"Our residents are constantly asking to do more hands-on work," he said, noting such workplaces as the Intensive Care Unit, where residents get the chance to think on their feet rather than working routine rounds.
Al Jayyousi said the program currently has 30 graduating residency students.
Klappa said he and fellow residents are prepared for any changes in the residency system.
"We’ve got a lot of hard-working interns and residents here," he said. "I don’t think there’s anything to worry about.