Q&A: The ACGME board’s first DO chair-elect talks about evolving residency

AOA Past President Karen J. Nichols, DO, faced obstacles as a woman during her medical training. When she started practicing medicine in Arizona in 1985, she encountered challenges both as a woman and as a DO. Women were underrepresented in medicine and few DOs worked in Arizona.

“On some rotations as a medical student, it was made perfectly clear that women were not well-accepted in the medical profession,” says Dr. Nichols, noting that when she joined the staff of the osteopathic hospital in Mesa, Arizona, there were only two female physicians among its staff of about 180 physicians. Other facilities didn’t grant privileges to DOs, which prevented her from treating one of her own patients who had been admitted to a nearby rehab hospital.

Despite the obstacles, Dr. Nichols thrived in medicine and emerged as a leader in the osteopathic world. She became president of the AOA, president of the Arizona Osteopathic Medical Association and president of the American College of Osteopathic Internists, and was the first woman to hold each role.

Recently, the Accreditation Council for Graduate Medical Education (ACGME) announced Dr. Nichols as the chair-elect of its board of directors, a position she will hold for one year before serving a two-year term as board chair. She’s the first DO and the third woman in the role and has served on ACGME’s board since 2015.

The DO recently spoke with Dr. Nichols about her new role, women in medicine and the single GME accreditation system. Following is an edited Q&A.

What does it mean to you that ACGME selected a DO as chair-elect?

I am very proud to be the first DO in this role. It’s absolutely an honor to be elected. And in this role, I’ll be serving ACGME as a physician first and a DO second.

What happens in this board is that we are not representing the interests of any one group. We come together as physicians, hospital administrators and public members to make the very best decisions to meet the ACGME’s mission, which is to improve health care and population health by assessing and advancing the quality of resident physicians’ education through accreditation.

What kind of work will you be doing as chair-elect and chair of ACGME’s board?

Being chair-elect is like being AOA president-elect. You’re working under the direction of the chair, and you’re there to fill in if the chair is not available.

As chair, you are the presiding officer over all the ACGME board meetings.

How do the actions of the ACGME board impact residency training?

The board oversees the development of ACGME’s common program requirements (CPR), which are the standards every residency program must align with to get or keep their accreditation. CPR are updated every seven to 10 years. They were most recently updated in July.

One recent action we’ve taken is to include diversity in ACGME’s CPR. We’ve recognized that providing appropriate diversity and inclusion is important for residents and faculty, so ACGME also has a senior vice president of diversity who just started.

The board has been concerned that we would need more residencies in rural and underserved areas, so we recently approved a task force to look into what it would take to promote more residencies in these areas.

We’ve also identified that the clinical learning environment has a big impact on how successful residents are in learning their specialty. We helped develop a new program called CLER, which stands for clinical learning environment review and helps institutions that host residency programs better assess their clinical learning environment and resident wellness.

You’re well-known in the profession for being a trailblazer for women as well as a mentor and role model. What advice would you offer to today’s female medical students and young DOs?

Know that every opportunity is open to you as a woman and as a DO. That goes for both young men and women who are DOs. Things have changed so fast even in the last five years.

The focus on diversity and inclusion that we’re seeing now is so exciting. In the past, people in minority groups have felt that they didn’t have a seat at the table, but that is changing rapidly and it’s very exciting to see. There were so many assumptions that I had to live under as a woman in medicine that are not there anymore.

What are some of the assumptions you had to live under?

When I graduated from medical school, only 15% of practicing physicians were women. Anything I did, few woman had been there before. For example, when I was on my surgery rotation as a student, the hospital I was at had never had a female student physician assist in surgery, so I had to change in the nurses’ lounge. There was no expectation that a woman would ever be in the doctors’ lounge.

In medical school, I got a lot of comments along the lines of, ‘You took the spot of one of my partners’ kids in medical school, and you’re just going to quit and have a family.’

Today people don’t have to carry that baggage with them. Half of all the people in medical school right now are women. We still have a long way to go, but my advice to anyone in medicine is don’t let anyone put boundaries and restrictions on you.

As someone familiar with the inner workings of ACGME, what are your thoughts on how the transition to a single GME accreditation system is going?

The single GME accreditation system is being implemented more successfully than anyone anticipated. DOs were welcomed with open arms when we joined as board members in 2015. We’ve had a warm and productive working relationship with every single board member since then.

Further reading:

PBS documentary covers women in osteopathic medicine

Correcting Wikipedia’s bias against women scientists

Residency programs in 4 specialties achieve 100% transition to ACGME accreditation