Complying with the ACGME’s core competencies

Residency Program Insider, October 19, 2005

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Dear residency program colleague:

How much sleep have you lost worrying about meeting the ACGME's core competencies? We all worry that we may not be teaching to this new "Holy Grail." However, in preparation for a recent AGME site visit, I realized that the competencies are exactly what residency programs have been doing for years-it's really a matter of semantics. Consider the following:

  • Patient care: This is what residency is all about! We are all constantly teaching residents patient care and evaluating their ability to provide patient care. With a little work, you can easily make your educational goals and objectives and your evaluation forms reflect the semantics of your particular RRC.

  • Medical knowledge: This is again a classic area of residency education. If you spell-out how you teach and evaluate a resident's medical knowledge, you have met the requirement. We use an annual departmental oral examination and the American Board of Surgery In-Training Examination to evaluate residents. Remember, the RRC is always interested in innovative teaching techniques. For example, I described on the PIF the advanced trauma operative management course we give to all PGY4 and PGY5 residents using cadavers, and the hands-on ultrasound course we give annually to all residents.

  • Practice-based learning and improvement: At first glance, this may seem like an area that residency training has not previously addressed. However, this is what our weekly morbidity and mortality conferences in surgery are all about. At Massachusetts General Hospital, we have a software program that allows us to track the incidence of complications and deaths to see if, in fact, our knowledge and discussion of complications affects the incidence of repeat "mal-events." We involve the residents in all projects to improve hospital performance in morbidity and mortality.

  • Interpersonal and communication skills: We teach these skills by our daily interactions with patients and families in the clinic and in the hospital. We evaluate them by actually observing how well residents communicate with others in these settings. There is no magic here. It is what every faculty member does every day. You just have to document it.

  • Professionalism: Do you ever correct a resident after you observe an unprofessional interaction? If so, you are teaching professionalism and you need to document it. In addition, we have an annual lecture on gender issues/harassment, a workshop on ethics, and a workshop on professional behavior. We have also added some categories to our resident evaluation form to evaluate a resident's performance in these areas.

  • Systems-based practice: I'm sure all residents in all programs today participate in multidisciplinary rounds and clinics on at least some services-document it! Residents are constantly working with consultants, physical therapy, occupational therapy, social services, etc. Be sure this is reflected in the program documentation. We involve residents in all of the committees that govern the functioning of the hospital; certainly this is training in systems-based practice.

Good residency programs have always done exactly what the general competencies require. As you fill out the PIF, think about what you have always done within the context of the competencies and then document it.

That's all for this week!

All the best,

Charles M. Ferguson, MD
Surgical Residency Program Director
Massachusetts General Hospital
Harvard Medical School

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