A Basic Guide to the ACGME General Competencies

1. A Basic Guide to the ACGME General Competencies Adapted from the CORD website by: Phil Levy, M.D. Gloria Kuhn, D.O. Bob Wahl, M.D. Wayne State University School of Medicine

2. IntroductionResponsibility of the Program • Teach the ACGME General Competencies • Assess the resident’s achievement of competence in each of the Core Competencies before graduation • Faculty development

3. IntroductionResponsibility of the Faculty • Know what the Core Competencies are • Commit (be prepared) to teach them • Commit (be prepared) to assess a resident’s progression to competency in each of them

4. Faculty Development Information pertinent to your knowledge and understanding of the core competencies will be provided to you via: • E-mail • Staff meetings • Faculty meetings • Distance learning

5. Gaining Medical knowledge • Clinical Experience : Most important aspect of training • Bedside teaching and learning transforms medical students into physicians

6. Slides in this Series • Define the competencies • Discuss meaning of the competencies • Faculty will be asked to attest that they have read the material, understand it, and commit to teach the competencies

7. Request Faculty • List the ACGME Core Competencies • Sign attestation • Return to Sandra Garling • E-mail (sgarling@med.wayne.edu) • Fax (745-3653 attn Sandra Garling) • Hard copy

8. What Are the Core Competencies ? • Six approved by ACGME in February 1999 • Patient Care • Medical Knowledge • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice

9. Definitions • ACGME provided the general language • Each specialty provided the detailed definitions • The Council of EM Residency Directors (CORD) held a series of consensus conferences to define for our specialty • Intellectual and procedural skills • Behaviors

10. Why Adopt A Competency Based Model? • Creates objective criteria for evaluation • Core competencies • Holds programs/educators accountable • Demonstrates effectiveness of efforts • Holds residents accountable

11. Current Reality • Programs must demonstrate provision of an educational experience that will ensure proficiency for all graduates in the core competencies • Programs must assess residents • Programs will be assessed

12. Core Competencies • Patient Care • Medical Knowledge • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice

13. Definition of Competency Patient Care 1 • Provision of timely, effective, appropriate and compassionate patient care 1 King et al. AEM 2002;9:1227-1235

14. Meaning Patient Care 1 The Resident: • Gathers accurate, essential information using all available sources • Integrates diagnostic information to form an appropriate differential diagnosis 1 King et al. AEM 2002;9:1227-1235

15. Meaning Patient Care 1 • Implements an effective management plan • Including treatment, consultation, disposition and pt. education • Resident has the capacity to perform essential • diagnostic, and • therapeutic procedures 1 King et al. AEM 2002;9:1227-1235

16. Meaning Patient Care 1 Simultaneously • Prioritize and stabilize • multiple patients • Perform other responsibilities 1 King et al. AEM 2002;9:1227-1235

17. Definition of CompetencyMedical Knowledge 1 • Use medical knowledge for clinical problem solving and decision-making • Identify life-threatening conditions • Formulate an appropriate differential diagnosis 1Wagner MJ AEM 2002, 9:1236–1241

18. MeaningMedical Knowledge 1 Specific immediate recall of information for care of critical patients Understand use of medical resources for immediate care Apply information to undifferentiated patient presentations 1Wagner MJ AEM 2002, 9:1236–1241 Wagner MJ AEM 2002, 9:1236–1241

19. Gaining Medical Knowledge • Didactic knowledge • Classroom • Independent study Bedside learning

20. Definition of CompetencyPractice-Based Learning and Improvement 1 • Understand patient care practices and assimilate necessary components for improvement 1 Hayden et al. AEM 2002;9:1242-1248

21. MeaningPractice-Based Learning and Improvement 1 • Use scientific evidence related to patient’s health problems and the larger population from which they are drawn • Scrutinize and critically interpret medical literature 1 Hayden et al. AEM 2002;9:1242-1248

22. MeaningPractice-Based Learning and Improvement 1 • Able to utilize information technology to effect patient care and education • Able to facilitate the education of colleagues and students 1 Hayden et al. AEM 2002;9:1242-1248

23. Definition of CompetencyInterpersonal and Communication Skills 1 • Able to conduct an effective information exchange with patients, their families and medical colleagues 1 Hobgood et al. AEM 2002;9:1257-1269

24. Meaning Interpersonal and Communication Skills 1 • Appropriate language • Ability to read body language of patient/families • Find an interpreter • Ask for questions • Repeat information if needed • Patience 1 Hobgood et al. AEM 2002;9:1257-1269

25. MeaningInterpersonal and Communication Skills 1 • Capable of creating a therapeutic relationship • Discuss condition with appropriate empathy • Demonstrate respect for cultural, ethnic, gender and age-related differences 1 Hobgood et al. AEM 2002;9:1257-1269

26. Meaning Interpersonal and Communication Skills 1 • Use of comprehensible written and spoken language • Able to interact in an adaptable manner 1 Hobgood et al. AEM 2002;9:1257-1269

27. Meaning Interpersonal and Communication Skills 1 • Able to negotiate and resolve conflict • Can function as an effective team member and leader • Capable of soliciting and implementing feedback 1 Hobgood et al. AEM 2002;9:1257-1269

28. Definition of CompetencyProfessionalism1 • Arrives on time, ready to work • Maintains a proper appearance • Inoffensive dress and appropriate cleanliness 1 Larkin et al. AEM 2002;9:1249-1256

29. Meaning Professionalism 1 • Respectfully interacts with patients, family, colleagues and the health care team • Proper introduction and manner of speech 1 Larkin et al. AEM 2002;9:1249-1256

30. Meaning Professionalism 1 • Demonstrates sensitivity to medical and emotional needs of patient • Appropriate use of humor/language • Maintains composure under stress 1 Larkin et al. AEM 2002;9:1249-1256

31. Meaning Professionalism 1 • Willingly sees patients throughout shift • Conscientious transfer of care (sign-out) • Punctual completion of medical records • Equitable in recruitment and peer review 1 Larkin et al. AEM 2002;9:1249-1256

32. Meaning Professionalism 1 • Demonstrates accountability, responsibility, and integrity !! 1 Larkin et al. AEM 2002;9:1249-1256

33. Definition of CompetencySystems-Based Practice 1 • Capacity to understand, access, and effectively utilize the resources of a given health care system to enable the provision of optimal emergency care 1 Dyne et al. AEM 2002;9:1270-1277

34. Computer system Social services Free clinics Our clinics Pharmacy Radiology Special Procedures Vascular laboratory Stroke team Cardio Team One Means Correctly Using Institution’s Resources

35. Means Correctly Using External Resources 1 • Ability to apply a working knowledge of different health care practice models and delivery systems to the treatment of an individual patient 1 Dyne et al. AEM 2002;9:1270-1277

36. Meaning • HMOs • PPOs • Medicare • Medicaid • Prescriptions • Dental • Extended care

37. Competency Objectives: Systems-Based Practice 1 • Practice cost-effective health care and resource allocation that does not compromise quality care 1 Dyne et al. AEM 2002;9:1270-1277

38. Meaning Systems-Based Practice 1 • Advocate for and facilitate patients’ advancement through the health care system 1 Dyne et al. AEM 2002;9:1270-1277

39. Teaching Modeling of behavior Bedside teaching Discussion Feedback Mentoring Didactic instruction

40. Teaching • Knowing the General Competencies • Making sure the residents’ practice and performance demonstrates attainment of the competencies

41. Teaching • Helping residents to improve in performance of the competencies • Evaluating junior and senior residents progression in attaining ability to practice the competencies • Evaluating the graduating residents’ attainment of the competencies

42. Methods of AssessmentGlobal Ratings of Performance • Description: • Rater judges general categories of ability • Ratings completed retrospectively based on general impressions collected over time • Rating scales • Use • End of rotation/summary assessments • Numeric ratings plus comments

43. Assessment • Staff/faculty meeting • Verbal discussion • Specific behaviors • Specific examples • Written documentation • Improvement • Correction for future improvement

44. FacultyLevel of training Behavior Problem solving

45. FacultyLevel of training • Behavior • Manage time • Interact with patients • Courtesy • Leadership

46. Ultimately Are they progressing in mastering the competencies? If not, what are the problems? Upon graduation, have they demonstrated proficiency/competency in the Core Competencies?

47. Summary Bulk of teaching by clinical attendings Modeling behavior Verbal instruction Discussion

48. Assessment Bulk of assessment /evaluation by clinical attendings

49. Evaluation of Resident Performance • On-line • New Innovations • Hard copy • Forms filled out and returned to the residency leadership team

50. Summary • Patient Care • Medical Knowledge • Practice-Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems-Based Practice