A consistent set of standards for the training, continuing education, and evaluation of family practice and internal medicine providers is necessary to maintain a high level of quality care for all patients. As such, in 1999, the Accreditation Council for Graduate Medical Education (ACGME) defined and outlined the six Core Competencies that they identified as the cornerstones for practicing resident physicians. Subsequently, the American Board of Medical Specialties (ABMS) followed suit and included these six principles into their Maintenance of Certification (MOC) programs.
Over the course of these blog articles, we have delved into the details of each of these standards. Individually, they represent key components in the behavior, attitude, and skill sets required to meet the qualifications for certification and medical practice. Together, they portray a complete picture of a well-rounded, successful medical professional providing the highest quality health care.
The six ACGME Core Competencies include:
- Practice-Based Learning and Improvement
- Patient Care and Procedural Skills
- Systems-Based Practice
- Medical Knowledge
- Interpersonal and Communication Skills
We began this blog series with a discussion of the ACGME Core Competencies, focusing on EPAs and Milestones. Each succeeding article has featured a specific ACGME Core Competency, exploring Practice-Based Learning and Improvement, Patient Care and Procedural Skills, Systems-Based Practice, Medical Knowledge, and Interpersonal and Communication Skills. In this final article in the series, we examine Professionalism, last but not least of the ACGME Core Competencies. To successfully master this attribute, residents must demonstrate a commitment to carrying out professional responsibilities while adhering to ethical principles and maintaining a sensitivity to the diverse patient populations that they serve. Characteristics such as respect, altruism, integrity, honesty, compassion, and empathy should be evident in all interactions, including with peers, supervisors, students, patients, and their families.
As the culmination of the ACGME Core Competencies, the Professionalism standard speaks directly to the attitude and behavior of the resident physician. The expectation for all medical professionals is that each and every one will treat all people with respect, compassion, and dignity. Patient needs will supersede a resident’s self-interest. And residents accept and understand that they are accountable to not only the patient but also to their colleagues and society as a whole.
Lastly, the Professionalism competency holds fast to the principle of treating all the diverse patient populations with sensitivity and respect. A professional physician will understand and recognize the unique effects of age, gender, culture, race, religion, disability, and sexual orientation on a patient’s health and well-being and act accordingly to provide care that is cognizant of these cultural ramifications.
To better evaluate a resident’s capabilities in the Professionalism Core Competency, the following subcompetencies give a more detailed breakdown of the attitudes and behaviors required. These include:
- Demonstrating Professional Conduct and Accountability
- Demonstrating Humanism and Cultural Proficiency
- Maintaining Emotional, Physical, and Mental Health, and Pursuing Continual Personal and Professional Growth
The ACGME Core Competencies: Subcompetencies for Professionalism
The subcompetencies for the ACGME Core Competency of Professionalism highlight a requirement for residents to conduct themselves as medical professionals in all instances. This includes presenting themselves in a manner befitting the role of a societal caregiver, placing the needs of others above their own, striving for continual improvement in their knowledge and skills, accepting responsibility, and treating all people with respect and dignity.
Demonstrating Professional Conduct and Accountability
How physicians present themselves to peers, patients, and families can have a direct impact on the responsiveness received in return. Residents and practicing physicians should always strive to be on time and prepared for their work interactions. They should dress appropriately and with cleanliness. While on duty, a resident should see patients throughout their entire shift; complete medical records thoroughly, honestly, and punctually; consistently advocate for patients and their families; and give and receive input and advice from colleagues.
Physicians should also accept accountability and admit their errors, maintain self-awareness of their own limitations, consistently evaluate their knowledge base and strive to improve it, and seek guidance and supervision as needed. They are team players. Supporting and working cooperatively with all staff, residents should provide a thorough and complete patient experience, using all available resources to serve each individual’s needs. All business practices should be handled ethically, and any potential ethical dilemmas should be raised as needed to the appropriate ethics committees for guidance and resolution.
Demonstrating Humanism and Cultural Proficiency
Qualifying physicians recognize that they are treating humans, not subjects. Honoring the humanity of the patient means constantly regarding each individual’s worth and dignity. Simple acts of respect are observed, for example, shaking hands and introducing themselves to all parties. Resident physicians will listen attentively, responding humanely to the concerns of patients and their families. The privacy of a patient is always maintained and confidentiality protected in all instances.
A resident can also demonstrate the ACGME Core Competency of Professionalism by exhibiting an attitude of altruism and advocacy, displaying an unselfish regard for and devotion to the welfare of patients and their families. The physician should act as an advocate for the patient’s welfare as it relates to health care.
Lastly, a resident physician displays empathy for his or her patients and an awareness of the unique qualties of each individual patient, including attributes like gender, age, ethnicity, emotional state, disability, and sexual orientation. Residents should show an understanding of the effects of these attributes on a patient’s health, well-being, and perception of the need for and application of health care.
Maintaining Emotional, Physical, and Mental Health, and Pursues Continual Personal and Professional Growth
Although this Core Competency calls for physicians to be self-sacrificing, that does not mean that altruism should come at the expense of a resident’s health. Physicians must set an example for their patients. Maintaining their own healthy lifestyle is paramount to obtaining acceptance and agreement from patients in establishing health management plans to better improve their quality of life.
Professionalism also means professional growth and demands that a resident will hold fast to the desire for a lifelong-learning approach to the practice of medicine — long after their initial medical training has concluded. Regular attendance at conferences, active enhancement of medical knowledge, and a positive response to constructive criticism are necessary to continue personal and professional growth in the health care field throughout a physician’s career.
Concluding the ACGME Core Competencies
As we wrap up our study of these ACGME Core Competencies with this final article in the series, we can look back at the underlying themes present in each one. Whether a physician is in the initial phases of their medical training or a seasoned provider, the following principles should consistently be present:
- A thirst for new knowledge
- A dedication to patients and their families
- A commitment to using scientific principles to investigate, diagnose, and develop treatment plans
- A respectful and professional demeanor in all interactions
For almost two decades, the ACGME Core Competencies have evolved to create the standards by which resident physicians are initially and continually educated, trained, and evaluated. The ACGME Core Competencies provide a framework to hone the behaviors, attitudes, and skill sets of medical professionals, so that the health care field consistently provides quality care to all patients and their families.
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)
Thank you for this article series. As chair of our CCC, I plan on sharing the series with our faculty to increase their depth of understanding of our milestones assessment.
This is something every physician should read.
Great to see more information regarding the massive amounts of training that doctors/physicians engage in prior to independent practice. However, residents are not providers, they are physicians. These ACGME rules apply to no other category of trainee in health-care. As i am sure you are aware, the AMA recently passed (with the AOA following suit this week) a resolution regarding the use of the term provider in regards to addressing physicians. This article’s use of the word in a piece where no other healthcare trainee is discussed downplays the role and extensive training that physicians uniquely complete. It is in direct contradiction to the formal positions of the AMA and son the AOA.
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