The Challenges and Impact of Evolving Competency-based Medical Education and Practice

Abstract

In clinical care, much of the emphasis is appropriately focused on evidence-based practice, atient safety, and quality outcomes. However, a closely related evolving dynamic is aimed at ssessing, attaining, and maintaining competence in practice. This evolution has the potential for ajor, even revolutionary, changes in medical education and practice at all levels. Medical education in the United States has undergone a significant transformation over he past several decades, ranging from medical school (undergraduate medical education UME]), to residency training (graduate medical education [GME]), and continuing medical ducation (CME). In some respects, this evolution has occurred in each area independent of he others, but clearly there are overlapping themes, with significant impact on the rofessional activities of both experienced and neophyte physicians. Each of these arenas of education is governed by separate professional accrediting rganizations, ostensibly independent of each other but, again, coordinated in regard to ertain strategies and policies. UME is directed and monitored by the Liaison Committee on edical Education (LCME), which governs U.S. medical school curriculum content and tructure to ensure standards of basic education and training of physicians. GME is ontrolled by the Accreditation Council on Graduate Medical Education (ACGME), which ets institutional standards for organizations that sponsor GME, as well as common program equirements, which govern the structure and function of all ACGME-accredited residency raining programs. In addition, the ACGME is organized into 26 residency review commitees (RRC), which set standards for training in each medical specialty (including physical edicine and rehabilitation [PM&R]), as well as first postgraduate year training programs. he Accreditation Council on Continuing Medical Education (ACCME) in turn sets policies nd accrediting standards for any organization that desires to designate educational activiies for the American Medical Association Physicians’ Recognition Award category 1 CME redits. Each of these organizations periodically surveys its constituents regarding complince with established standards (the LCME surveys medical schools, the ACGME RRCs urvey residency programs, and the ACCME surveys CME providers), with varying cycle urations, depending on the degree of compliance. Another organization with roles in both UME and GME, the Association of American edical Colleges (AAMC), initiated a debate regarding learning objectives for medical tudents, which culminated in the Medical School Objectives Project in 1998, which dentified the following attributes of medical school graduates: altruistic, knowledgeable, killful, and dutiful [1]. More or less concurrently, the ACGME undertook a process to better define and haracterize physician “competence,” and, in 1999, evolved a 4-phase “Outcome Project” 2], with goals for assessing resident performance and instilling specific knowledge, skills, nd attitudes in 6 “core” or “general competencies”: