Residency

Document tough competencies

Residency Program Connection, January 30, 2007

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Document tough competencies

As graduate medical education shifts toward a learner-based educational approach, programs must demonstrate that residents actually achieve measurable outcomes. Residency programs must identify learning objectives related to the ACGME general competencies and use increasingly more dependable (i.e. objective) methods of assessing residents' attainment of competency-based objectives.

To fulfill competency requirements, programs should develop outcomes-based curriculum. Each curriculum should include all six competencies and be based on Residency Review Committee requirements. Keep in mind that most existing curricula in an institution can be adapted to an outcomes-based format. To do this, program administrators must decide whether their current assessment methods are appropriate for each educational outcome in a given curriculum. If not, new assessment tools should be developed and evaluated.

There are many different strategies to documenting the six core competencies, each of which encompasses multiple skill sets. Two of the competencies (patient care and medical knowledge) are specialty-specific; the remaining four (professionalism, systems-based practice, practice-based learning and improvement, and interpersonal and communication skills) are cross-disciplinary. The following measures can be used for the tougher-to-measure competencies of communications skills, professionalism, systems-based practice, and practice-based learning and improvement.

Objective measurements include:

  • 360-degree evaluations
  • Patient evaluations
  • Simulation training
  • Manikins

    Competency measures for communications and professionalism include:

  • Peer evaluations in a non-threatening format
  • Self-evaluations at various points throughout a resident's year of training
  • Follow-up of patient complaints and/or kudos from the patient satisfaction department
  • Observation of resident discussion with family members on sensitive issues
  • Participation in patient and medical student education programs

    Competency measures for systems-based practice include:

  • Computerized Physician Order Entry training
  • Annual research poster presentation day
  • Resident support of research projects
  • Resident participation on hospital committees
  • Resident volunteer work in underserved areas

    Competency measures for practice-based learning and improvement include:

  • Compilation of a resident learning portfolio, including presentations, diary of situations demonstrating what was learned through research, and published articles or abstracts
  • Patient and procedure logs

    All the best,


    Henry Rosenburg, MD, CPE
    Director of medical education and clinical research
    Designated institution official
    Saint Barnabas Medical Center
    Livingston, NJ



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