#ACGME2024 Session Summary: Closing Plenary Highlights "Agents of Positive Change”

In an emotional and uplifting final session of the conference, ACGME President and Chief Executive Officer Thomas J. Nasca, MD, MACP conducted his last “Conversations with the CEO” session with the graduate medical education (GME) community. During his introductory remarks, ACGME Chief of Staff and Chief Education Officer Timothy P. Brigham, MDiv, MS, PhD spoke of how it took Dr. Nasca a year to convince him to join the ACGME 17 years ago. What finally sealed Dr. Brigham’s decision?

“He brought me to a conference… to meet all of you,” Dr. Brigham said, his voice tightening with emotion. “There are eight billion people in the world. There’s only one person I would have followed to do this. And that person is Tom Nasca.”

During the open Q and A session, Dr. Nasca fielded questions on topics ranging from GME finances and the future of the profession to the evolving roles of program directors and coordinators. He answered with honesty, optimism, and a call for everyone to join in the work of making medical education—and therefore health care in the US and beyond—more patient-centered and compassionate, one resident or fellow at a time.

When asked what keeps him up at night, Dr. Nasca said from 2020 to six months before the conference his worries were related to the COVID-19 pandemic, but that his concerns have shifted. “What keeps me awake now is the intrusions beyond the doctor/patient relationship.” Whether those intrusions are political, legal, or financial, he said, “it’s driving a wedge between our patients and our clinicians.”

His concern is that these influences will negatively affect the identity formation of young physicians as “they don’t know the previous environment when the doctor/patient relationship was sacrosanct.”

Professionalism and Compassion
When one attendee asked what makes a good doctor, Dr. Nasca said academics and clinical knowledge are necessary but not sufficient. With artificial intelligence, machine learning, and other technologies, knowledge acquisition will get easier. But some qualities are timeless, he said. “What will be core, what will not change—I don’t believe—is the need to relate to a person on an individual level, to care about that person and be willing to help them.”

When asked about reducing administrative burden on mid-sized and large Sponsoring Institutions during the ACGME’s Annual Update, Dr. Nasca invited the community to help find solutions, but noted that the ACGME has “a responsibility to collect information from you and make decisions,” noting that it is a core element of a profession “to agree to be monitored by your peers.”

He also acknowledged the evolving role of coordinators in GME, while drawing a boundary between the ACGME’s and an individual institution’s roles. The ACGME does not and cannot classify job roles in any institutions, “but what we can do is define the capabilities and the responsibilities as standards” that can then be used by coordinators to lobby for job reclassifications. The Common Program Requirements will come up for review in 2025, which will give the GME community opportunities to explore and request such changes, he said.

When asked for insight and advice on how programs in rural areas can compete against large academic hospitals in metropolitan areas, Dr. Nasca acknowledged it can be a challenge. He suggested leveraging the funding for rural tracks available from the federal government, through which a rural site could partner with a larger Sponsoring Institution. He also suggested looking for residents/fellows who come from rural areas, as data show physicians tend to practice in the environments where they study, and students from rural communities will likely be more inclined to want to learn and work in a rural setting.

A common thread in his answers was Dr. Nasca’s underpinning belief that to achieve true excellence as a physician, technical and clinical skill are not enough. “Altruism, compassion, a willingness to commit to a life of learning, to submit to peer evaluation, those are the elements of professionalism that must exist,” he said.

Looking to the Future
When asked what excites him about the future of medicine, Dr. Nasca gestured to the audience. “Being here with you excites me,” he said. “The fact that there are so many people here to learn how to make medicine better—that excites me. I see the direction of medicine and its advances curing people that we couldn’t cure when I was a resident. I see this opportunity to make medical education more humanistic tomorrow than it was yesterday. I see you as agents of positive change and that enriches my view of the future immensely.”

After the questions ended, ACGME Board of Directors Chair Claudia Wyatt-Johnson, MA and Chair-Elect George E. Thibault, MD announced two surprises that will create a living legacy for Dr. Nasca at the ACGME. The Thomas J. Nasca, MD Professionalism Award, which will undergo development via the Awards Committee of the Board, will be presented for the first time in 2026. And moving forward, beginning next year, this plenary, the final session of the ACGME Annual Educational Conference, will be named the Thomas J. Nasca Lecture.