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Graduate medical education programs in the United States
are facing major changes. The Accreditation Council
for Graduate Medical Education (ACGME) has launched
an Outcome Project that is impacting two fundamental
aspects of training.
- The ACGME has broadened the required content of
physician education by adopting six general competencies,
including new categories of Systems-Based Practice
and Practice-Based Learning and Improvement.
- The standards for accreditation are shifting focus
to outcomes and assessment of learners using competency-focused
evaluation tools.
The timeframe for transforming residency training is
quite extended, but programs need to be acting now.
The ACGME has specified a four-phase process.
- Phase 1 - "Forming an initial response to changes
in requirements," ended in June 2002.
- Phase 2 - "Sharpening the focus and definition
of the competencies and assessment tools," runs
from July 2002 through June 2006
- Phase 3 - "Full integration of the competencies
and their assessment with learning and clinical care,"
extends through June 2011.
- Phase 4 - "Expansion of the competencies and
their assessment to develop models of excellence"
is an ongoing process of improvement in training across
the country.
On September 26-28, 2002, Tufts Health Care Institute
and Partnerships for Quality Education are co-hosting
a national conference devoted exclusively to educating
physicians in two of the six competencies: Systems-Based
Practice and Practice-Based Learning and Improvement.
For more on this event, see the Conference
Home Page. THCI has also been developing courseware,
assessment instruments, and other instructional resources
that are described and/or posted at www.thci.org.
A growing body of information for GME programs is available
online. Listed below are some websites and resources
that program directors, faculty, and residents can access
to learn more about the Outcome Project overall and
about innovations and best practices for meeting the
new requirements in specific competencies and content
areas.
- Perhaps the best place to start is the Accreditation
Council for Graduate Medical Education's own website.
Under the heading "Competencies and Outcomes
Assessment" you can find the ACGME Outcome Project.
The extensive set of information and resources include
descriptions of the project and competencies, bibliographies,
sample assessment instruments, reports of initiatives
at different programs, and links to other websites
and resources. Also on this site, you can download
the March 2002 issue of the ACGME Bulletin, focused
entirely on the Outcome Project and the general competencies.
- The Association
for Hospital Medical Education offers resources
for members and others on topics of interest, including
the new GME requirements. AHME News Online has published
reference materials on core competencies. Also available
are presentations on the Outcome Project from the
spring 2002 Education Institute.
- Academic organizations are beginning to provide
resources for their members. One group that has posted
a variety of materials including links and member-created
resources is the Association
of Program Directors in Internal Medicine. Items
are accessible to anyone visiting this website.
- The American Board of Medical Specialties (ABMS)
has collaborated with ACGME in defining the competencies
and adapting them for each specialty. In addition,
the ABMS guidelines on maintenance of certification
also require assessment of the same set of general
competencies for practicing physicians. A brief essay
by James Youker, MD, on Systems-Based Practice can
be found in the ABMS
Record, Summer 2001.
- Some articles of interest are cited at the end of
this piece.
THCI will continue to devote much of its website and
resources, including these Topics, to helping program
directors and faculty meet the challenge of training
physicians for the new practice environment. We invite
you to send information about resources, online and
in print, that are worth recommending to colleagues.
Please contact Ralph Halpern, THCI Director of Content
Development and Program Evaluation, at Ralph_Halpern@tufts-health.com.
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