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Preparing for ACGME Competencies
David B. Nash, MD, MBA, is the Dr Raymond C. and Doris N. Grandon professor of health policy, and chairman, Department of Health Policy, Jefferson Medical College. Here, he says that teaching and evaluating the new ACGME competencies is a critical challenge to graduate medical education for residency programs across the nation, and a describes how that challenge can be met. First, Dr. Nash delineates the problem, stating that doctors are well prepared in the science and skills required for practice, but largely lack the training to improve care and patient safety. Education for health professionals needs to take into account new information, changing patterns of practice, a focus on patient safety and improved quality, and "customer relations." It should also involve teamwork, understanding work as a process and willingness to learn from one's mistakes. The author describes the ACGME's two main core competencies designed to bring about these changes: Practice-based Learning and Improvement (PBLI) and Systems-Based Practice, which requires students to demonstrate awareness of and responsiveness to the larger context and system of healthcare. How to teach those competencies? Dr. Nash enumerates several strategies, including strong leadership, relevance to everyday practice, interdisciplinary work, and experiential learning. He stresses the importance of building measurement into everyday practice, using a number of criteria proposed by Dr Donald Berwick, president and co-founder of the Institute for Healthcare improvement. The author covers the components of a good portfolio, which includes creating a collegial atmosphere, developing self-assessment skills, and an opportunity for structured feedback. And a part of systems-based practice, he says, is partnering with managed care organizations. The lecture continues with a discussion of evaluation tools and performance ratings, and describes the Quality Improvement Knowledge Application Tool (QIKAT) which differentiates between those with quality improvement training and those without. It covers an innovative approach to assessing both PBLI and Systems-based Practice put forth by the American Board of Internal Medicine. It concludes with a look at the future of medical education research, recommending additional federal funding, and possibly creation of a National Institute for Medical Education Research. |
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