Graduate
Medical Education programs are being held to a new set
of standards in the 21st century, the standards set
by the Outcomes Project of the Accreditation Council
for Graduate Medical Education (ACGME). The Outcomes
Project uses, as a lynchpin, the concept of General
Competencies, and the six General Competencies as defined
by the ACGME are:
 Medical
Knowledge - Patient
Care
- Interpersonal
and Communication Skills
- Professionalism
- Practice-Based
Learning and Improvement
- Systems-Based
Practice
The
Outcomes Project has three phases, briefly described
as follows:
Phase
One: Define objectives and assure trainees
the requisite experiences to achieve competence in the
six aforementioned realms.
Phase
Two: Establish valid and reliable assessments
of the six general competencies and aggregate trainee
data to present to the GMEC to evaluate and improve
the training program.
Phase
Three: Begin to use external outcome data to
continuously improve the training program.
Accreditation
site visits now center on determining the degree to
which programs and institutions are moving to accomplish
the goals of the Outcomes Project. The aim is to eventually
concentrate little on the specific experiences which
comprise a training program, and instead evaluate the
trainee and patient outcomes that arise from a given
program. Every program is being challenged to employ
varied assessments of its trainees (Standardized Patient
Exercises, Portfolio reviews, 360 degree evaluations,
Chart reviews, others) rather than relying on the Multiple
Choice Test as the arbiter of competence in every realm.
This
huge project takes place against a backdrop of higher
clinical demands on faculty and shrinking GME funding.
Centralization of effort and sharing of ideas and resources
is going to be the only sensible way to adequately respond
to the challenge that the ACGME has placed before us,
and will hopefully be employed in ways that benefit
trainees and patients.
Occurring
in parallel to the ACGME Outcomes Project is the challenge
presented by the Institute of Medicine’s report
“Crossing the Quality Chasm.” This report
has placed a spotlight on medical errors, thought to
result in at least 98,000 patient deaths per year. The
goals of the Outcomes Project (better outcomes for patients)
and of increasing the safety of patients in our system
mesh beautifully—and our trainees represent the
best resource for finding the solutions to patient safety
problems.
The
GME landscape is full of change for our trainees, promise
for the patients they care for, and challenge for the
physicians who choose to participate in training the
next generation of caretakers. Graduate medical education
is integral to every function of the Academic Medical
Center. Excellence in GME is a worthy goal with benefits
for all.
Dianne
Wagner, MD
Associate Dean of Graduate Medical Education |
