Enhancing Flexibility in Graduate Medical Education

Project Overview

Insight worked with the Council on Graduate Medical Education (COGME) to develop a Congressional Report on removing barriers to achieving an expanded and more appropriately trained physician workforce. For more than 25 years, COGME has advised Congress and the Secretary of the U.S. Department of Health and Human Services (HHS) on the adequacy of the supply and distribution of physicians in the United States; current and future shortages of physicians; and related graduate medical education (GME), accreditation, and financing issues.

“Enhancing Flexibility in Graduate Medical Education,” COGME’s 19th Report to Congress, addressed the need to change the structure, design, accreditation, and financing of GME to meet the needs of the expanding training requirements of the physician workforce. The committee, though direct research and presentations from key national experts, explored the history of the development of GME; changes in Federal and State policy that have impacted the needs of physician training; and existing financial, structural, and policy barriers to meeting expanding training requirements.

The resulting report addressed Federal efforts to achieve the following:

  • Expand the number of GME trainees.
  • Improve how GME is delivered to address the health care needs of the Nation adequately.

The report also made recommendations on how to meet these projected needs. COGME found that to address these issues, increased flexibility is needed in terms of how GME training is structured, designed, accredited, and funded. The COGME report presented 4 recommendations to Congress, addressing specifically the need to:

  1. Align GME with future health care needs.
  2. Broaden the definition of “training venue” (beyond that of traditional venues).
  3. Remove regulatory barriers limiting flexible training programs and training venues.
  4. Make accountability for the public’s health the driving force for GME.

Core Activities

Literature Reviews and Environmental Scans; Policy Analysis and Assessment; Stakeholder Engagement and Coordination of Advisory Committees and Technical Expert Panels; Report Development and Presentation


The final report is entitled “Enhancing Flexibility in Graduate Medical Education.” (September 2007)