The Outcome Project and the General Competencies
[Note: The following material is based in part on an introduction to the Outcome Project found on the ACGME Website at " www.acgme.org/outcome/project/proHome.asp ".]
The Accreditation Council for Graduate Medical Education
To understand the General Competencies, one must be familiar with the Accreditation Council for Graduate Medical Education (ACGME) and the ACGME Outcome Project. In brief, the ACGME is a private, non-profit organization that evaluates and accredits medical residency programs throughout the United States. The ACGME establishes national standards by which it approves and assesses programs in graduate medical education using the most effective, valid, fair, open, and ethical evaluation methods available. The organization's mission is "to improve the quality of health care in the United States by ensuring and improving the quality of graduate medical education for physicians in training." This mission is carried out through the work of residency review committees comprised of physician representatives appointed by member organizations and medical specialty boards and operating with delegated accreditation authority from the ACGME. Member organizations include the American Board of Medical Specialties, American Hospital Assn., American Medical Assn., Association of American Medical Colleges, and the Council of Medical Specialty Societies.
The Outcome Project
The Outcome Project, as described on the ACGME Website is "a long-term initiative by which the ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs." The project was initiated in keeping with the ACGME's mission to ensure and improve the quality of graduate medical education in the United States and involves a fundamental change in the focus of the ACGME's activities from measuring a residency's "potential" to educate residents, by evaluating the program's compliance with existing regulations, to assessing actual outcomes of the educational process. This process involved moving from a regulation and prescription based model to...
Development of the General Competencies
Recognizing current trends and concerns, the Outcome Project leadership identified six core domains on which programs would focus their efforts to improve the educational and assessment processes. Over time these six domains have become known as the "General Competencies" and have served an important role in creating a common language and syntax for discussion and development of the educational and assessment processes in medicine. The General Competencies were identified after the careful study of research on physician competencies and in consideration of input from the various stakeholders and constituencies involved. The six General Competencies developed by the Outcome Project Advisory Committee are:
- Patient Care
- Medical Knowledge
- Systems-based Practice
- Practice-based Learning and Improvement
- Interpersonal and Communications Skills
In February of 1999, the ACGME endorsed the committee's six General Competencies and in September 1999 approved minimum language regarding these competencies that must be a part of each residency program's requirements. In this module, you will examine each of the six General Competencies to better understand the domain of knowledge, skills, attitudes, and activities to which each applies and to enable you to better focus on the development of each competency. Currently, programs are expected to demonstrate that they are developing educational activities and implementing assessment tools that provide useful and increasingly valid, reliable evidence that their residents are achieving competency-based objectives and that the programs themselves are effective in preparing residents for medical practice. Transitioning from a focus on compliance with meeting ACGME regulations to establishing measurable objectives and assessment tools will take time. As you complete your residency, you will probably notice the shift in emphasis from a focus on process to an emphasis on outcomes. You, in fact, will be part of this transition as you will be expected to take an increasingly responsible role in identifying your strengths and opportunities for growth and building on the first while strengthening the latter. In the end, you must demonstrate your competency in each domain to sufficient degree that your program director is confident in attesting to your competency.
The Toolbox of Assessment Methods
The second key aspect of the ACGME General Competencies requirements and the second major component of the Outcome Project is the identification and development of tools to measure the progress of residents and programs in meeting the objectives defined. The "evaluation" clause of the requirements states that "the residency program must demonstrate that it has an effective plan for assessing resident performance throughout the program and for utilizing assessment results to improve resident performance" and furthermore that "the residency program should have in place a process for using resident and performance assessment results together with other program evaluation results to improve the residency program." Toward this end, the ACGME's Susan Swing collaborated with the American Board of Medical Specialties' (ABMS) Phillip Bashook to develop an inventory...