Community Discernment: Getting Nonprocedural Documentation Right—A First Step to Exemplary Accreditation

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Although the Graduate Medical Educational community has had much experience with procedural case logs, they have had little with nonprocedural case logs. Practical experiences are at the heart of physician development. It is important for residents to reflect on their experiences, for program directors to understand the range of experiences actually achieved by each of their residents, and for regulators including both the residency review committee and the boards to have information to determine whether programs and residents meet standards for accreditation and certification. Although some of the lessons learned from procedural case logs will be helpful in determining how best to implement nonprocedural case logs, in general, new ground is being broken. An opportunity exists for the graduate medical education community to engage in a series of clarifying conversations about how to best capture the authentic experiences of residents and how to use the information to promote improvement. Conditions that will help the community discern the best path forward include: clarity of purpose, commonly agreed-upon principles, and the creation of a reliable structure for communication and feedback—a structure that enables trust and improvement. On June 22, 2006, representatives of the Association of Program Directors in Pediatrics (APPD), the Pediatric Residency Review Committee (RRC), and the Accreditation Council for Graduate Medical Education (ACGME) met to have a conversation about how best to proceed with the implementation of the nonprocedural case logs focused on capturing the continuity clinic experience. ACGME’s new mission, vision, values, and strategic priorities guided its perspective. ACGME’s mission is to improve health care by assessing and advancing the quality of resident physicians’ education through accreditation. Its vision is exemplary education. Its values are accountability, excellence, and professionalism. These values constitute principles that could guide ongoing dialogue. By accountability, ACGME requires that its processes are open and transparent; that it is responsive to both the educational community and the health of the public; and that its results are reliable, valid, and consistent. By excellence, it means accreditation that is efficient and effective, outcomes-based, improvement oriented, and innovative. By professionalism, ACGME means that its actions are respectful and collaborative, responsive, ethical, and fair. The ACGME recently completed a self-study that in