A consistent standard of care is imperative for quality healthcare to occur. It provides patients with a comfort level and sense of expectation for diagnosis and treatment. It also allows physicians to streamline their collaboration, being confident that all medical providers are subscribing to the same guidelines and protocols. The outline for this standard of care was established in 1999 when the Accreditation Council for Graduate Medical Education (ACGME), the governing body for graduate level medical training programs, defined their set of six Core Competencies, including Medical Knowledge.
These Core Competencies define the basic skill sets and behavioral attributes deemed a requirement for every resident and practicing physician. Their success is measured in terms of the ability to: 1) administer a high level of care to diagnose and treat illness, 2) offer and implement strategies to improve patient health, 3) provide resources for disease prevention, and 4) support patients’ and families’ emotional needs while also treating their physical needs.
Therefore, these competencies are incorporated into the training and continuing education of almost every major medical education program. This includes the adoption by the American Board of Medical Specialties (ABMS), and, later, the integration of the ACGME Core Competencies into the Maintenance of Certification (MOC) program.
The ACGME Core Competencies are defined as:
- Practice-Based Learning and Improvement
- Patient Care and Procedural Skills
- Systems-Based Practice
- Medical Knowledge
- Interpersonal and Communication Skills
In Part 1 of this blog series, we listed the ACGME Core Competencies with a focus on EPAs and Milestones. Other articles in this series have addressed Practice-Based Learning and Improvement, Patient Care and Procedural Skills, and Systems-Based Practice. In this article, we break down the various components of the Medical Knowledge core competency. Each ACGME Core Competency represents a necessary skill set and attitude for training and practicing physicians to continually hone and develop. Medical Knowledge includes an understanding of all established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences. However, resident physicians must also go beyond simply obtaining medical knowledge for themselves. They must also demonstrate the ability to apply it to patient care and appropriately and enthusiastically transfer that knowledge to others.
Medicine is constantly evolving, and even a seasoned physician with years of experience hasn’t “seen it all.” A desire for and an understanding of the need for a lifelong-learning approach to the practice of medicine is a requisite attribute for physicians providing quality health care. For this reason, the ACGME Core Competency of Medical Knowledge seeks to ensure that residents are trained to continually investigate, question, and seek new knowledge. But knowledge without application is fruitless. Sharing those best practices with medical colleagues and employing that knowledge in the diagnosis and treatment of patients is equally as important as obtaining it.
The ACGME Core Competencies: Sub-competencies for Medical Knowledge
The Medical Knowledge subcompetencies break down into manageable pieces—the skills and attributes that comprise this core competency. These include being able to demonstrate:
- An investigative and analytical approach to clinical problem solving and knowledge acquisition
- An ability to apply medical knowledge to clinical situations
- An ability to teach others
Investigative and Analytical Approach
First and foremost, residents must always maintain an open mind. They will demonstrate a willingness to never shy away from asking questions and searching out new and useful sources of information. They will consider alternative or additional diagnoses, seeking and initiating discussions with faculty. The continual search for medical knowledge includes identifying both universal and individualized goals and objectives for learning, at every stage in a resident’s career. This includes an awareness of areas needing improvement and a humility to absorb and process feedback on areas where growth is needed.
The lifelong-learner attribute is evidenced by the physician’s commitment to querying literature and texts on a regular basis, attending conferences, and critically evaluating new medical information and scientific evidence in order to modify their knowledge base accordingly.
Apply Medical Knowledge to Clinical Situations
The acquisition of medical knowledge must continually circulate back to the application of it and provide better and more relevant, quality patient care. Residents will demonstrate competence through the combination of a physical exam and interpretation of ancillary studies, such as laboratory work and imaging, to form a working diagnosis and initiate a therapeutic approach.
The application of medical knowledge should also be measured using Miller’s Pyramid, a framework for assessing clinical competence developed in 1990. According to it, a resident progresses from “Knows” to “Knows How” to “Shows How” to “Does.” The “Does” component is the key: what a resident may know and be able to demonstrate in a controlled setting should match how they perform in actual day-to-day interactions with patients on a regular basis.
Subsequently, a physician exemplifying the attributes of this core competency will apply the evidence-based medical skills and knowledge that they have obtained in a patient-centered approach, and do so consistently. It is a skill set that is evidenced and witnessed in all patient interactions and clinical situations, not just testing scenarios.
Finally, competent residents pay attention to the clinical outcomes first and foremost, but in a manner that takes into consideration the cost-effectiveness, the risk-benefit ratio, and patient preferences.
Ability to Teach Others
Obtaining and applying medical knowledge skills is essential for delivering quality health care. But they cannot survive in a vacuum. Practitioners must regularly participate in the act of sharing knowledge. Being a lifelong learner is only half of the equation. The other half requires the ability to teach and pass along to others the experiences and knowledge each individual has acquired through the years. To successfully embody the Medical Knowledge Core Competency, a resident needs to demonstrate the ability to educate others in an organized, enthusiastic, and effective manner.
Medical knowledge is where all medical education begins. And it never ends. Residents must understand that the continual process of investigating, questioning, and learning is an integral part of what makes residents and physicians successful, and contributes to the growth and improvement of the health care field as a whole.
Read more about the six ACGME Core Competencies:
- Exploring the ACGME Core Competencies (Part 1 of 7)
- Exploring the ACGME Core Competencies: Patient Care and Procedural Skills (Part 3 of 7)
- Exploring the ACGME Core Competencies: Systems-Based Practice (Part 4 of 7)
- Exploring the ACGME Core Competencies: Medical Knowledge (Part 5 of 7)
- Exploring the ACGME Core Competencies: Interpersonal and Communication Skills (Part 6 of 7)
- Exploring the ACGME Core Competencies: Professionalism (Part 7 of 7)
i feel that if medical students entering residency do not recognize the role of the ACGME or understand the competencies by which they will be evaluated, it. is difficult to assess the efficacy, utility, and success of the Outcome Project
Medical knowledge is one competency that is most important to a physician’s practice. It is an ongoing activity that needs self commitment to be up-to-date with current concepts. It is a reality that the busier a physician is in his/her clinical practice, the less time he/she has for reading. This sounds contradictory but is true. It is also important to distinguish continuing competency from continuing education as one can be educated but not competent or vice versa both of which are dangerous.