Leaders in Medical Education

Dr. Patrick Alguire, Senior Vice President of Medical Education at the American College of Physicians

Osmosis Team
May 28, 2014

With more than 137,000 members, the American College of Physicians is the largest medical-specialty organization and second largest physician group in the United States. They are well known for their contributions to medical education, including the seminal Medical Knowledge Self Assessment Program (MKSAP) that tens of thousands of medical students and residents use each year to pass shelf and board exams. We had the opportunity to speak with Dr. Patrick Alguire, the Senior Vice President for Medical Education at the ACP, about his career path in medical education and internal medicine.

How did you decide on a career in medicine?
A career in medicine seemed out of reach for me until my older brother was accepted to medical school. That was the first time that the idea bubbled up that I too could be a doctor. I always enjoyed the sciences and saw an opportunity to combine by intellectual leanings with and exciting career.

What made you pick internal medicine as a specialty?
The concept of solving puzzles that alluded others first attracted me to internal medicine. It was only after I became a physician that it became clear to me that patient contact and following patients over a number years was the most rewarding aspect of internal medicine.

It seems that more medical students are pursuing interdisciplinary careers and degrees (MD/MPH, MD/MBA, etc). Can you describe how you managed to combine your career in medicine with your interest in education?
My interest in education began as a resident where I took special interest in teaching medical students and received positive feedback for my efforts. I soon realized that teaching was the best way for me to stay current in medicine. There was a short leap from teaching to designing curricula and measuring educational impact. But overall, it was the daily contact with interested learners and their appreciation for my efforts that reinforced my decision to remain in academic medicine and focus on education.

Every few weeks there appears to be a new report discussing burnout rates of physicians and the fact that many would decide not to pursue medicine if given the chance. In this somewhat disheartening environment, do you have any advice for current medical students about avoiding burnout?
Most physicians deliver care in a system that is frustrating by design. Physicians have not learned to create a health care team and be the leader of that team delivering high quality care. Instead physicians, for the most part, continue providing care where they are personally responsible for every element in a patient's health care delivery. This results in physicians being over-taxed, performing functions for which they were never trained, or are over-trained, and spending less time with the patient. Physicians also feel over-regulated by well meaning quality initiatives but have not been successfully woven into the work flow of patient care. New ways of delivering care are needed, such as the creation of patient-centered medical homes that focus on team-based care of patients.

What are the top three things you would change about the way we train our physicians?
The nation should have a comprehensive work force strategy with the goal of providing the types of physicians we need in the right locations. This will require financial incentives for students and training programs to produce the desired outcomes. Students and residents should have more training away from the academic medical center and more training in community health centers or physician offices, allowing first contact and true longitudinal care of patients. Finally, students and residents need training and practice in patient safety and quality improvement skills.