BY HOLLY EDMISTON
MEDICAL SCHOOL MAY TEACH THE BASICS, but it is postgraduate education that truly prepares young physicians to independently practice medicine. The Accreditation Council for Graduate Medical Education (ACGME) is the main accrediting body for U.S. residency and fellowship programs. At Washington University School of Medicine, the Office of the Associate Dean for Graduate Medical Education (GME) maintains oversight of accreditation for all postgraduate clinical training.
That effort is headed by Rebecca P. McAlister, MD, professor of obstetrics and gynecology and associate dean for graduate medical education, and Tia O. Drake, director, graduate medical education.
“The job of the ACGME and our office is to ensure that our programs meet established standards,” says McAlister. “We ensure that we maintain a quality educational environment for all upper-level trainees in any of the residency and clinical fellowship training programs at the university or our affiliated hospitals.”
The GME office heads the Washington University Barnes-Jewish Hospital St. Louis Children's Hospital Educational Consortium. Postgraduate trainees can be employed at any of the three institutions, but the oversight for the educational environment resides with the GME office, while the hospitals focus on patient care and the physical environment.
“Our primary goal is to ensure that the people we turn out at the end of their training are competent in an array of areas,” says Drake. "These include their medical knowledge, their professionalism, and their ability to communicate."
Rebecca P. McAlister, MD, far left, and Tia O. Drake, far right, meet regularly with residents, fellows and their program directors to discuss issues related to postgraduate clinical training.
Enjae Jung, MD, in the OR.
A bond of trust
Fourth-year surgery resident Enjae Jung, MD, is actually in her sixth year of post-MD training. After earning her medical degree at Washington University School of Medicine in 2006, she completed two years of residency, followed by two years conducting basic research.
According to Mary E. Klingensmith, MD, the Mary Culver Distinguished Professor of Surgery and director for the general surgical residency program, it is not uncommon among surgery residency programs for trainees to spend two years conducting dedicated postdoctoral research. This training builds a foundation for future academic research and funding; it also gives residents an edge when applying for competitive fellowship positions.
Jung’s passion for surgery was ignited when she shadowed a surgeon as an undergraduate. She applied to medical school intent on specializing in surgery and has never wavered from that goal.
“I love the bond I share with my patients,” says Jung. “There’s a lot of trust in allowing someone to operate on you, and there’s a lot of emotional investment when you’ve operated on someone.”
She credits the people who run, teach and participate in the surgery residency program at Washington University with making her experience so successful, and she notes that the GME office also plays an important role.
“The faculty are approach- able and interested in my education and training.”
— ENJAE JUNG, MD
“The Department of Surgery leadership has put measures into place that maximize our learning while remaining compliant with ACGME restrictions, such as restriction of duty hours,” says Jung.
Compliance with duty hours and maintenance of a quality educational environment for trainees is a primary focus for the GME office. According to Klingensmith, McAlister and Drake are readily available for advice and insight when daily challenges in running a residency program arise.
Jung plans to take advantage of an early specialization program, an opportunity offered for physicians interested in doing a fellowship in vascular surgery. As she completes her fifth year of general surgery, she will begin a two-year fellowship in vascular surgery.
Other aspects of the program also support the transition from training to beginning a career.
“The faculty are national leaders, yet they are approachable and interested in my education and training,” says Jung. “I also have great colleagues; my fellow residents are supportive, and we definitely look out for each other.” CLOSE ▲
Amit Patel, MD, left, and Melvin S. Blanchard, MD, examine patient Janet Garner.
Amit Patel, MD, a second-year resident in internal medicine and a 2010 graduate of the School of Medicine, has a passion for research.
While patient care remains his focus, he currently is participating in CSTAR (Clinical Science Training and Research), a residency training pathway that allows for three months of uninterrupted, dedicated clinical research time.
“When you’re on clinical rotations, our demanding hours can make it difficult to partake in research,” says Patel. “CSTAR offers residents interested in clinical research the opportunity to learn how to prepare proposals and conduct research that will assist them in becoming successful clinician-investigators.”
Like his research mentor, C. Prakash Gyawali, MD, professor of medicine, Patel plans to specialize in gastroenterology. The field includes an interesting array of procedures and emerging technologies, but will still allow Patel to build long-term relationships with his patients.
Patel also serves on the Washington University Institutional Review Board and is co-authoring several chapters in the Washington Manual Subspecialty Consult Series, and serves as a senior staff writer at iMedicalApps.com.
“The GME staff does a terrific job. They stand ready to ensure that our education is both expansive and fair.”
— AMIT PATEL, MD
“We have a number of special programs, including career and research mentorship, training in how to conduct clinical research, training in quality improvement, and education in global health,” says Melvin S. Blanchard, MD, FACP, associate professor of medicine, chief of the Division of Medical Education, and director of the Internal Medicine Residency Program.
Programs like these are what make residency opportunities at Washington University School of Medicine unique. The educational oversight of the GME office ensures that every clinical program offered meets ACGME guidelines.
That’s a safeguard Patel appreciates.
“The GME staff does a terrific job,” he says. “They stand ready to ensure that our education is both expansive and fair.”
Blanchard concurs, saying: “Dr. McAlister and Tia Drake are very responsive, efficient and enthusiastic. They are very supportive of our educational programs and curriculum, and their oversight helps us facilitate the sharing of ideas across the 82 training programs at Washington University.”
Even with protections in place, residency training remains a challenging and difficult endeavor.
“You have to love what you do,” says Patel. “No doubt residency can be exhausting at times, but if you love taking care of patients and making them feel better, you embrace its challenge and finish each day with a sense of fulfillment.” CLOSE ▲
Sara W. Dyrstad, MD, left, and Jennifer E. Gould, MD, study an image in the interventional radiology suite.
Different every day
Figuring out the etiology of a patient’s presenting symptoms is what drew Sara W. Dyrstad, MD, to radiology, a specialty that requires careful study of anatomy and pathology using an array of imaging techniques and procedures.
“Radiology is a fascinating, challenging field that allows me to have focused patient interaction and to communicate with clinicians from a variety of specialties,” says Dyrstad, who earned her medical degree in 2007 at Southern Illinois University in Springfield, Ill. “No day is ever the same.”
Throughout residency training, Dyrstad has channeled her passion for problem-solving beyond medical issues to those that arise outside the imaging suite.
Representing the Missouri State Medical Association as a section delegate for the Resident and Fellow Section of the American Medical Association (AMA), she has been active in the national discourse about postgraduate education.
“As contributing GMEC members, we get to voice our concerns.”
— SARA W. DYRSTAD, MD
“Sara’s involvement with the AMA underscores her commitment to radiology and the future of medicine,” says interventional radiologist Jennifer E. Gould, MD, assistant professor of radiology and diagnostic radiology residency program director. “That commitment, coupled with her level-headed approach to issues, made her an easy choice as a resident representative to the GME Consortium committee.”
For the past year and a half, Dyrstad and three other postgraduate trainees have served on the committee, composed of GME and hospital administrators, residency and fellowship program directors, and residents and fellows. Most recently, they have focused on providing a peer forum for postgraduates to help address any possible concerns that may arise during their training.
“It’s great to be a contributing member to the GMEC,” says Dyrstad. “Not only do we get to voice our concerns, we also gain insight into global issues that affect residency training, such as duty hour restrictions, and possible program changes.”
“Sara has been a delight to have as a resident,” says Gould. “She has matured over her four years of training to become a leader. Her ‘can-do’ attitude and willingness to jump in and work hard make her a pleasure to have on service.” CLOSE ▲