Anticipatory Education
ACGME President and CEO Dr. Nasca kicked off his Saturday morning session at the Annual Educational Conference with some “non-rhetorical” questions:
- Can anyone predict what the health care system will look like in 2035?
- Can anyone predict how long your residents will practice? 40 years?
After stumping the room, he went on to explain that it is our job is to prepare residents to practice in the future—not to arm them with practices, skills, and knowledge of the present. We want our residents to be prepared not just for 2018 but for 2035—and beyond.
Physicians are trained to think in short, linear steps—because that’s what the patient needs. But we also need to think about what the residents will need in the future. We need to shift our thinking to “anticipatory education,” not reactive or retrospective education, by looking at 2050 and 2060—the time period in which our residents will be practicing.
We are living in the health care system of now, so how do we plan for inevitable future changes in the health care delivery system? One way the ACGME is tackling this and other questions around the “uncertain future of medicine” is by using a future scenario planning approach to strategic planning and thinking.
Rehearsing the Future
Co-presenter Tom Thomas, the ACGME’s new Vice President for Strategic Planning, gave a high-level explanation of the process of future scenario planning. How does an organization plan for the future? As Mr. Thomas explains, “There is no data about the future! Most of the data we have is about the past—I would argue we don’t even have good data about the present. Most current data are at least six months old.”
Future scenario planning is not about predicting the future. It’s about shifting the paradigm: instead of trying to forecasting the future, the key is to change your thinking—developing a mindset to managing the uncertainties and ambiguities of your future. Reset your ultimate goal to creating an organization that thinks and acts with strategic intent. The world is not static. Today’s trends are not enduring. Most likely, your strategic surprises will come from sources outside your profession. Scenario planning is risk management in a strategic setting.
The answer Mr. Thomas offers is portfolio analysis. In 2014, the ACGME completed an extensive strategic planning process that involved developing four “future worlds,” or scenarios. This portfolio of diverse scenarios did not contain any mention of accreditation, ACGME, medical education, or even health care to begin with (we layered these features in through a series of facilitated workshops). We then looked at strategies for the ACGME that might work in each world, and concluded by determining which of those strategies worked across all worlds.
Dr. Nasca explained how the ACGME has used its portfolio of scenarios and its strategies in different settings, from guiding Board meeting agendas and framing our SI2025 initiative, to informing the thinking around revising the Program Requirements for Internal Medicine.
Those scenarios, set in 2035, are ready to be refreshed. The ACGME has recently embarked on its second scenario planning process, kicked off at the recent February Board meeting. The process will last 18-24 months, and will involve input from over 200 individuals, in and out of the ACGME, when all is said and done, as this type of strategic planning benefits from the input of as many people as possible.
Would you like to help?
If you have ideas, insights, or consideration about what you think life will be like in in 2050, we invite you to share with us, in a few paragraphs, or perhaps through books or articles you think would be helpful. Please send us your ideas. It doesn’t have to be about health care—it can be about anything. We are most interested in ideas about societal “forces for change” – things outside of medicine that will impact medical delivery or medical education, such as AI and big data or climate change. Remember: most of our strategic surprises will most likely come from outside health care.