The impact of the new competencies on resident education in ophthalmology

Abstract

The Accreditation Council for Graduate Medical Education (ACGME) is a private professional organization that is responsible for the accreditation of residency education programs, including ophthalmology training. The ACGME has identified new specific core competencies designed to cross specialty lines to assure public confidence and to promote excellence in the medical educational system. Three primary external stakeholders have driven the process: the public (e.g., private and public health organizations and foundations), the government (e.g., regulatory and reimbursement agencies), and the market (e.g., third-party payers, industry, insurance companies, health care networks). The ACGME process began in July 2001 and was the product of input and feedback from representatives from the external and internal (e.g., residents, program directors and chairmen, allied health professionals) stakeholders. The 6 ACGME competencies are (1) patient care, (2) medical knowledge, (3) practice-based learning and improvement, (4) interpersonal and communication skills, (5) professionalism, and (6) systems-based practice. The American Board of Ophthalmology added a seventh competency to the list, surgery. The reader is referred to the ACGME website for more detailed descriptions of the 6 competencies. To meet the new ACGME competencies, residency programs have been invited to participate in a longterm educational process that will span a 10-year timeline. This educational process will require the following: (1) defining specific objectives for teaching the competencies, (2) providing evidence of learning across the competencies, (3) providing evidence for assessment of the competencies, and (4) use of assessments for programmatic improvement directly linked to educational outcomes. The ACGME competencies will require a significant commitment from academic ophthalmology to meet the long-term goals of the project. In some cases, we will simply modify the methods that we use to assess resident performance (different forms, 360° evaluations, and portfolio development [see companion editorial]), but in others, we will need to incorporate new topics, tools, and teaching methodologies. These competencies are intentionally broad to allow maximum flexibility among specialties to design teaching and assessment methods (tools) that are best suited to meeting the needs of the individual specialty. The ACGME recommends that the assessment tools meet certain criteria, including validity (“test measures what we think it measures”), reliability, and feasibility. This will represent simultaneously our greatest challenge and our greatest opportunity. We must develop an educational curriculum and tools that are not overly burdensome but are at the same time reliable, valid, and based on sound adult learning principles. Table 1 lists possible methods and curriculum changes for teaching and evaluating the competencies. Standardized patients, web-based learning, journal clubs, teaching videos, surgical practice laboratories and simulators, chart-stimulated recall of patients, oral examinations, and interdepartmental teaching efforts are likely to be included early on in the new curriculum. In addition, the assessment system must (1) be consistent with the curriculum and program objectives, (2) be representative of the educational domains of interest, (3) use multiple instruments, (4) conduct multiple observations, (5) use multiple observers, (6) assess performance using prespecified criteria or standards, and (7) be fair. The re-engineering process of resident education in ophthalmology mandated by the ACGME competencies will require 3 fundamental paradigm shifts. First, we must move from the traditional accreditation model to a competency model. In the traditional model, programs were reviewed and achieved accreditation in a yes or no manner. The competency model acknowledges that there is a range of performance across programs and among individuals. The old model, with its emphasis on medical knowledge (“know how”), must evolve to a system that measures actual performance (“show how”). Performance will require more than medical knowledge and patient care, incorporating the less traditional competencies of professionalism, interpersonal and communication skills, systemsbased practice, and practice-based learning and improvement. Only by measurement and improvement Guest Editorials