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Competencies (Part 1 of 7)
By NEJM Knowledge+ Team|June 2nd, 2016|Learning|2 Comments
In this series of blog posts, we will offer a detailed overview of each of the ACGME
Core Competencies. We will also outline the milestones associated with learning
and fulfilling ACGME Core Competencies in different medical specialties.
More recently, the ACGME has worked with ABMS member boards to develop
specific milestones for each specialty that support the overarching 6 competencies.
Milestones provide a framework by which residents and later, physicians, can be
evaluated, using key elements of each competency that a physician is expected to
demonstrate. By determining the knowledge, skills, and other attributes that attend
each ACGME Core Competency and its subcompetencies, the ACGME can
quantify not only the readiness of residents, but the efficacy of medical training
programs.
The milestones are assessed along a scale from “not yet assessable” to
“aspirational.” Each stage on this scale measures competence assuming the
residents will begin at one end of the scale and, as they acquire further knowledge
and training, move up the scale to the final level.
At the low end of the scale, a resident may exhibit “critical deficiencies,” which
means the learner behaviors indicate a significant lack in performance, and are not
within the spectrum of developing competence. As a resident moves upward
through the scale, he or she may exhibit the behaviors of an early learner, then an
advanced learner who displays improvement in ability.
The ACGME is now laying the groundwork to move residency programs toward
using Entrustable Professional Activities (EPAs) as a core part of resident
competency assessment. While the milestones might be somewhat abstract and
require assumptions about knowledge, the EPAs are all supposed to be
observable activities. For example, an EPA for a pediatric hospitalist might be:
serve as the primary admitting pediatrician for previously well children suffering
from common acute problems and for a family medicine trainee might include
“Evaluate and manage undifferentiated symptoms and complex conditions.”
Boards, societies, and education researchers are still developing specialty-specific
EPAs, and these are not yet widely in use in resident evaluation.