source: The ACGME |
Competencies
- Patient Care - Gather data; order
diagnostic tests; interpret data; make decisions; perform procedures;
manage patient therapies; work with others to provide patient-focused
care.
- Medical Knowledge - Fund of knowledge;
active use of knowledge to solve medical problems.
- Practice-Based Learning & Improvement
- Analyze practice performance and carry out needed improvements;
locate and apply scientific evidence to the care of patients;
critically appraise the scientific literature; use the computer
to support learning and patient care; facilitate the learning
of other health care professionals.
- Interpersonal & Communication Skills
- Develop a therapeutic relationship with patients and their families;
use verbal and non-verbal skills to communicate effectively with
patients and their families; work effectively as a team member
or leader.
- Professionalism - Demonstrate
integrity and honesty; accept responsibility; act in the best
interest of the patient; demonstrate sensitivity to patients'
ethnicity, age, and disabilities.
- Systems-Based Practice - Demonstrate
awareness of interdependencies in the health care system that
affect quality of care; provide cost-effective care; advocate
for quality patient care; work with hospital management and interdisciplinary
teams to improve patient care.
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Assessment Methods
- Clinical Performance Ratings
- Monthly, rotation, semi-annual or annual ratings of resident
performance
- Focused Observation and Evaluation
- Supervisor/attending observation of individual resident-patient
encounters, operations, specimen preparation, etc., and concurrent
(same day) evaluation
- 360 Assessments - Evaluation
by MDs (supervisors, residents, medical students) and non-MDs
(nurses, technicians, social workers, PAs ) using the same or
similar evaluation forms<
- Evaluation Committee - Evaluation
of resident performance in a small group discussion format, e.g.,
Evaluation Committee
- Structured Case Discussions -
An informal structured mini-oral exam consisting of a small set
of pre-determined questions; the exam occurs during a resident's
case presentation to his/her supervisor
- Stimulated Chart Recall - Uses
a resident's patient records in an oral exam-like format to explore
decisions made and patient management; is conducted "after the
fact" using patient charts to stimulate memory of the case
- Standardized Patient - The resident
provides care to an SP as if (s)he were a real patient and is
evaluated concurrently by the SP or another trained observer;
the SP is a well person or actual patient trained to present a
case in a standardized way
- OSCE - A multi-station exam of
simulated clinical tasks, which might include SPs, anatomical
models, X-ray interpretation, lab test interpretation, etc.; a
resident performs the tasks and is evaluated concurrently by a
trained observer
- High Tech Simulators/Simulations
- Residents' performance of procedures on a high-tech simulator
(e.g., Harvey) is evaluated; this may involve built-in evaluation
by the simulator or observation and concurrent evaluation.
- Anatomic or Animal Models - Residents'
performance of procedures on non-computerized, 3-dimensional models
that replicate the properties of human anatomical structures is
observed and evaluated concurrently
- Role-play or Simulations - Residents
are evaluated based on their performance on assigned responsibilities
in a staged replica of a potentially real situation, e.g., mobilization
of medical team in a multi-victim accident, confrontation of an
"impaired" colleague, negotiation with administration regarding
facilities and equipment upgrade
- Formal Oral Exam- "Mock" oral
exam in which an examiner asks residents questions about what
to do in a clinical scenario presented verbally or role played
by the examiner
- In-training Exams - A multiple-choice
exam developed by an external vendor
- In-house Written Exams - A multiple
choice exam developed by residency program faculty
- Multimedia Exam - A computer
based multiple choice or branching question exam in which authentic
visual and auditory patient information is presented as question
information
- Practice/Billing Audit - Educational
equivalent of physician profiling; this data-based process benchmarks
individual resident billing data against peers in the office,
hospital, or managed care setting
- Review of Case or Procedure Log
- Review of number of cases or procedures performed and comparison
against minimum numbers required
- Review of Patient Chart/Record
- Involves abstraction of information from patient records, such
as tests ordered, and comparison of findings against accepted
patient care standards
- Review of Patient Outcomes -
Aggregation of outcomes of patients cared for by a resident and
compared against a standard
- Review of Drug Prescribing -
Systematic review of drug prescribing for selected conditions
to determine adherence to protocol
- Resident Project Report (Portfolio)
- Evaluation of resident work products, such as reports of research
studies, practice improvement, or systems-based improvement
- Resident Experience Narrative (Portfolio)
- Evaluation of performance based on residents' narratives of
critical incidences or other experiences, usually accompanied
by reflection on the event, e.g., what happened, why, what could
have been done differently
- Other Portfolio - Evaluation
of resident performance based on other work/performance products
not included above, e.g., audiotapes, slide presentations
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Educational Activities
- Clinical Teaching - teaching
that occurs in the clinic, EDs, ORs, laboratories, or other medical
settings and addresses issues related to residents’
current patient cases or clinical responsibilities.
- Clinical Experiences - direct,
hands-on clinical or patient care activities. This may include
surgery, patient exams, the reading of radiographs and preparation
of pathology assays.
- Performance Feedback - information
provided to a resident that describes what (s)he has done well
or poorly and provides specific guidance as to how performance
might be improved.
- Departmental Conferences, Lectures
or Discussions - formal, classroom instruction on a specific topic
or method, led by one or more faculty, residents, or staff, etc.
- Institutional Conferences, Lectures,
or Discussions - formal educational event involving institution-sponsored
grand rounds, lectures, discussions, or workshops for residents
and/or faculty from multiple specialties; may be part of an institutional
core curriculum (i.e. a set or course of learning activities arranged
to impart knowledge and skills in fundamental domains, for example,
communication skills, legal issues, ethics).
- Individual or Group Projects
- multi-step, multi-component tasks performed as vehicles for
learning and applying knowledge and skills. Projects should result
in a product. Examples are literature reviews, research, clinical
quality improvement projects, and community health advocacy work.
- Computer Modules - computer-based
instructional units that present medical knowledge or clinical
tasks, etc, that residents work through independently. These modules
are developed either by the institution/program or purchased from
commercial vendors
.
- Standardized Patients - professional
actors or real patients trained to present realistically and reliably
a medical condition and/or specific patient behaviors; the standardized
patient provides instruction to the resident or feedback about
his/her performance.
- High-Tech Simulators/Simulations -
3-dimensional, high tech, computerized devices that represent
human anatomy and physiological responses (simulators) are used
by residents to learn procedures and operations. Or realistic
patient care scenarios are generated using high tech/virtual reality
devices (simulations). Residents engage in the scenario as in
real life to learn or apply clinical or teamwork skills.
- Anatomic or Animal Models - non-computerized,
3-dimensional devices that replicate the properties of human anatomical
structures are used by residents to learn procedures.
- Role Play or Simulations - staged
replicas of potentially real situations are engaged in by residents
to learn, practice or rehearse skills needed in those situations.
This method is often used in difficult or high-risk situations,
e.g. mobilization of a medical team in a multi-victim accident
or confrontation of an “impaired “ colleague.
- Games - informal activities with
goals, rules, rewards and penalties for various courses of action.
Games may be computerized, played individually or in groups, facilitated
or self-paced.
- Role Modeling - portrayal of
desired professional behaviors, communication skills, or clinical
skills, etc. by attending/supervising physician with the expectation
that residents will learn these behaviors and skills by observing
the role models.
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Assessment Terminology
- Criteria - specific behaviors,
actions, outcomes, or product characteristics that are indicative
of how well clinical work or learning tasks have been performed
and are used as standards for evaluating performance. Points on
a rating scale, such as "satisfactory " or "unsatisfactory
" are not criteria.
- Evaluator training- occurs (minimally) if evaluators review and
discuss the criteria and (more robustly) if they practice using the criteria and
resolve differences in evaluations of the same sample performance.
- Objective standards - pre-determined scores, ratings, or patterns
of ratings and comments that trigger specific educational decisions such as a
requirement for remediation or denial of promotion to the next level of training.
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Improvements
- Learning Objectives - statements that describe the specific knowledge,
skills, and attitudes residents are expected to obtain as a result
of participating in educational activities.
- Faculty Development - formal educational activities in the form
of workshops, discussions, or lectures which have as their goal improving
faculty knowledge about the General Competencies and their ability
to teach and assess the competencies.
- Clinical Experiences - direct, hands-on clinical or patient care
activities. This may include surgery, patient exams, the reading of radiographs and preparation of pathology assays.
- Clinical Teaching - teaching that occurs in the clinic, EDs, ORs,
laboratories, or other medical settings and addresses issues related to residents' current patient cases or clinical responsibilities.
- Performance Feedback - information provided (orally or in writing)
to a resident that informs him or her of what (s)he has done well or poorly and provides specific guidance as to how performance might
be improved.
- Departmental Conferences, Lectures or Discussions - formal, classroom
instruction on a specific topic or method, led by one or more faculty, residents, or staff, etc.
- Institutional Conferences, Lectures, or Discussions - formal educational
event involving institution-sponsored grand rounds, lectures, discussions, or workshops for residents and/or faculty from multiple specialties;
may be part of an institutional core curriculum (i.e. a set or course of learning activities arranged to impart knowledge and skills in
fundamental domains, for example, communication skills, legal issues, ethics).
- Required Reading - Required Reading
- Individual or Group Projects - multi-step, multi-component tasks performed as vehicles for learning and applying knowledge and skills.
Projects should result in a product. Examples are literature reviews, research, clinical quality improvement projects, and community health
advocacy work.
- Computer Modules - computer-based instructional units that present
medical knowledge or clinical tasks, etc, that residents work through
independently. These modules are developed either by the institution/program
or purchased from commercial vendors.
- Standardized Patients - professional actors or real patients trained
to present realistically and reliably a medical condition and /or
specific patient behaviors; the standardized patient provides instruction
to the resident or assesses performance and provides feedback.
- High-Tech Simulators/Simulations - 3-dimensional, high tech, computerized
devices that represent human anatomy and physiological responses (simulators)
are used by residents to learn procedures and operations. Or realistic
patient care scenarios are generated using high tech/virtual reality
devices (simulations). Residents engage in the scenario as in real
life to learn or apply clinical or teamwork skills.
- Anatomic or Animal Models - non-computerized, 3-dimensional devices
that replicate the properties of human anatomical structures are used
by residents to learn procedures.
- Role-Play or Simulations - staged replicas of potentially real
situations are engaged in by residents to learn, practice or rehearse
skills needed in those situations. This method is often used in difficult
or high-risk situations, e.g. mobilization of a medical team in a
multi-victim accident or confrontation of an impaired colleague.
- Games - informal activities with goals, rules, rewards and penalties
for various courses of action. Games may be computerized, played individually
or in groups, faciliated or self-paced.
- Clinical Performance Ratings - new or revised monthly, rotation,
semi-annual or annual ratings of resident performance.
- Focused Observation & Evaluation - formal, concurrent (same
day) written evaluation following supervisors / attending observation
of individual resident-patient encounters, operations, specimen preparation,
etc.; might involve videotaping and formal, current, written assessment
of the videotaped performance.
- 360 Assessment - evaluation by MDs (supervisors, residents, medical
students) and non-MDs (nurses, technicians, social workers, PAs) using
the same or similar evaluation forms.
- Formal Oral Exam- oral exam in which an examiner
asks residents questions about what to do in a clinical scenario presented
verbally or role played by the examiner.
- Portfolio Assessment - evaluations of resident learning or performance
based on resident work products, such as reports of research studies,
improvement projects, presentation slides or on residents' narratives
of critical incidences or other experiences
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