Population Health and Graduate Medical Education: Updates to the ACGME's Common Program Requirements.

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) revised its mission, ‘‘We improve health care and population health by assessing and advancing the quality of resident physicians’ education through accreditation,’’ adding ‘‘population health’’ explicitly to its charge. This change reflects the importance of population health in the preparation of resident physicians to meet the Triple Aim. The ACGME fulfills its mission in graduate medical education (GME) through efforts that support ongoing assessment and evaluation of individual learners, programs, and sponsoring institutions. The Common Program Requirements (CPRs) are the accreditation standards that outline the structure, processes, and outcomes that define common characteristics of specialty and subspecialty educational programs for physicians in the United States. The CPRs provide the basis for the ACGME’s accreditation decisions, evaluation of the competencies, and requirements for training applicable to all specialties. Over the last 4 years the CPRs have undergone a major revision. This effort was accomplished in 2 phases following the review of requested comments and recommendations from more than 120 medical organizations, societies, certifying entities, residents, and others. The Phase 1 Task Force was charged with conducting an in-depth review of Section VI of the CPRs that addresses the characteristics of the resident work and learning environment. They were informed by emerging concern over resident and faculty wellbeing. In 2017, the Phase 1 Task Force announced a major revision to Section VI of the CPRs, incorporating new requirements centered around resident work hours, physician well-being, and support. The Phase 2 Task Force initiated its efforts to revise the remaining sections of the CPRs (Sections I–V) with an evidence-based approach, outlining the philosophy and intent of the updated standards. The new requirements are effective July 1, 2019, with a few exceptions and will be fully implemented as of July 1, 2020. It is in Sections I–V that the interface between the program and the community it serves and the health of the public emerges in philosophy and standards. The revision of the CPRs follows a report published by the Institute of Medicine (IOM), titled Graduate Medical Education That Meets the Nation’s Health Needs. While the IOM committee’s charge was primarily focused on GME governance and financing, the entire report centered around GME that ‘‘supports the nation’s health and health care goals, as articulated in the ‘triple aim. ’’’ This basic tenet is reiterated in the first goal of the committee to ‘‘encourage production of a physician workforce better prepared to work in, to help lead, and to continually improve an evolving health care delivery system that can provide better individual care, better population health, and lower cost. ’’ The factors that lead to improved population health outcomes encompass a broad range of interventions from safety and quality in the acute care setting to improved behavioral and social conditions, with the latter having the greatest impact on health outcomes overall. Despite this awareness, social spending as a ratio to health care spending in the United States lags behind that of other industrialized countries, a factor likely contributing to poor health outcomes in the United States compared to other nations. These poor outcomes are disproportionately concentrated in regions and populations across the country. Using life expectancy as a measure of health status, for example, life expectancy by county in the United States in 2014 ranged from approximately 66 years to 87 years, a more than 20-year difference. The importance of population health in educating the next generation of physicians is critical to addressing these disparities. Physicians need to understand the impact of factors in both the medical delivery system and the social environment that contribute to health outcomes. DOI: http://dx.doi. org/10.4300/JGME-D-19-00267.1