The ACGME Outcome Project

OVERVIEW

[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 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 one in which acceptable levels of performance are pulled continually upward through a routine of introspection, identification of opportunities for improvement, and well planned efforts to attain a higher level of effectiveness. Assessing outcomes, furthermore, requires that residency programs establish measurable learning objectives and the means for determining the degree to which individual residents and the programs meet these objectives. These means must include ever more dependable and objective measures of assessing the resident's competency regarding the objectives. Realizing that the educational process is one that develops and changes over time, the ACGME also looks closely at how a program implements a plan for continuous reflection and improvement.

Several factors and trends developing in the 1980s and 90s stimulated the move from process-based evaluation to outcomes-based measurement. These included:

growing concern about the preparedness of physicians to cope with an increasingly volatile and constantly changing health care system
society's expectation that physicians minister to social and psychological as well as physical infirmities ¹
recognition of the public's need for assurances that residency programs are producing well-qualified physicians through cost-effective programs
increased focus on outcomes versus process in industry and education
recognition that ultimate focus of our educational system should be neither the learners nor the instruction itself, but rather the level of patient care provided by our learners
the U.S. Department of Education's emphasis on outcomes assessment in the accreditation process
the need for outcomes-based data to inform discussion regarding the funding of medical education and patient safety
the need to encourage innovation and the pursuit of excellence rather than compliance with minimal threshold standards¹

Recognizing these 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."

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Click here for more about the General Competencies