A set of six Core Competencies was established in 1999 by the Accreditation Council for Graduate Medical Education (ACGME), the governing body for graduate level medical training programs. These standards set in place the foundation for the training and continuing education of every resident and practicing physician; and define the basic skill sets and behavioral attributes that are necessary to facilitate a successful medical practice and high-quality patient care. Subsequently, the American Board of Medical Specialties (ABMS) also adopted and integrated these competencies into the Maintenance of Certification (MOC) program.
As such, the ACGME Core Competencies are now widely accepted and incorporated across all medical education training programs. 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. In each succeeding article, we are conducting further exploration of specific ACGME Core Competencies. Part 2 examined the ACGME Core Competency of Practice-Based Learning and Improvement. This article delves into the components of the Patient Care and Procedural Skills core competency. Successful physicians who master the skills in this competency will provide effective care for the treatment of health problems in a way that is compassionate and developmentally appropriate. Simultaneously, they will also establish a symbiotic environment between patient and provider that promotes health maintenance and prevents problems.
Patient Care and Procedural Skills
The ACGME Core Competency of Patient Care and Procedural Skills highlights the necessity of physicians maintaining a patient-centered approach to health care. This entails forming a bond of trust between patient and provider. A physician will meet all the requirements for this competency when they are able to demonstrate an ability to listen and absorb medical histories, diagnose, properly inform and educate, and prescribe and perform necessary procedures in a way that maximizes patient comfort.
In a time where medical resources face increasing limitations, especially the amount of time physicians have to spend with each patient, the priority on patient care is a difficult conundrum. Also, new restrictions on duty hours, while intended to benefit residents by lightening workload and improve patient outcomes by ensuring that residents are not unduly affected by the stress of sleep deprivation while providing patient care, have led to residents having less time with patients. This means that residents have fewer patient encounters (read: a reduced opportunity for learning and practicing the skills required for patient care) and presents a challenge not only to the residents, but to the mentors who are trying to teach the ACGME Core Competency of Patient Care and Procedural Skills.
This is why it is even more important to educate new residents and remind seasoned professionals of the benefits and necessity of thorough patient care.
Residents and physicians that embody the competency of Patient Care and Procedural Skills will demonstrate their knowledge with the ability to:
- Gather essential and accurate information about the patient
- Counsel patients and family members
- Make informed diagnostic and therapeutic decisions
- Prescribe and perform essential medical procedures
- Provide effective health management, maintenance, and prevention guidance
Sub-Competencies for Patient Care and Procedural Skills
The Patient Care and Procedural Skills sub-competencies outline the knowledge, skills, and attributes that encompass this core competency. They are exemplified in residents and physicians who are able to provide care that is: 1) family-centered, 2) compassionate, 3) explained in developmentally appropriate terms, 4) an effective treatment of health problems, and 5) encouraging of overall health. As we look deeper, we see evidence of the following skills and character traits in resident physicians who meet all the requirements for this core competency.
Gather Essential and Accurate Information
A physician who understands the ACGME Core Competency of Patient Care understands the need to begin with a full and complete picture of the patient they are treating. Compiling a medical history requires gathering all the myriad details together from multiple sources in order to paint that complete picture.
Practitioners must first understand the chief complaint, a history of past and present illnesses, family background, and current symptoms before any diagnosis or treatment steps can begin. The ability to obtain these details commences with interviewing the patient and caregivers. Developmentally and age-appropriate conversations, questions and explanations are used when querying each individual party. Additional information resources are obtained through adjunctive sources (past procedures and chart information), personal observations, and a physical examination. The ability to compile essential and accurate information is a critical component to mastering this core competency and providing quality patient care.
Counsel Patients and Family Members
Patient Care must also include family care. Caregivers are an integral part in both the effective treatment of health problems, as well as preventative health maintenance. The ACGME Core Competency of Patient Care ensures that all parties, both the patient and their support system, are adequately informed and participatory throughout the entirety of the decision making processes. Providers will acknowledge and be sensitive to the hardships involved with diagnostics, treatment and recovery protocols for the patients and families they treat.
It also ensures physicians understand how to share news and results, both good and bad. The ability to relay sensitive information in a professional manner, while handling the normal emotional responses, is a hallmark of this core competency.
Make Informed Diagnostic and Therapeutic Decisions
Another marker of mastery of the Patient Care core competency is the ability to synthesize information from the patient, current scientific evidence, as well as laboratory tests and imaging studies, using clinical judgement to interpret the results and evaluate the medical problem in order to formulate a diagnosis. It is vitally important that physicians recognize their limitations at this stage. Comprehensive Patient Care includes seeking help as needed and requesting consultations from sub-specialists when information is incomplete, inadequate, or beyond the normal scope of practice for a provider.
Once a working diagnosis is established, the patient-centered focus for Patient Care must again become a priority by supporting patient preferences as therapeutic and treatment options are evaluated and decided upon.
Prescribe and Perform Essential Medical Procedures
The Procedural Skills component of this core competency is evaluated based on the performance of medical procedures, both invasive and non-invasive, that are considered essential for a physician’s designated scope of practice. Some medical specialty boards have developed lists of specific procedures that a resident must demonstrate competency in by the end of their residency: the American Board of Internal Medicine (ABIM) and American Board of Family Medicine (ABFM) for example. However, to meet the general requirement of this sub-competency, a resident must demonstrate the ability to :
- Recognize the indicators for procedures
- Describe the procedure in appropriate language for patients and caretakers
- Acknowledge the impact of the procedure on patient and family
- Competently perform all medical procedures required for their scope of practice
- Perform the procedure in a way that maximizes patient comfort
Physicians will demonstrate an openness to sharing best practices on procedures, as well as actively seeking and learning new and less invasive techniques that obtain similar results.
Provide Effective Health Management, Maintenance and Prevention Guidance
The final component to the Patient Care sub-competencies is demonstrating the ability to provide effective and anticipatory guidance to patients in order to establish a health maintenance and management plan designed to promote health and prevent potential health problems. A qualifying physician will take into consideration age, gender, risk factors, and developmental stages to identify areas of concern and attention, and not hesitate to discuss options for maximizing patient healthcare. As part of the patient-centered approach, this will include recognizing indicators for and performing screening tests, identifying community resources, and including family and caregiver support systems into the development and implementation of health management plans.
The ACGME has designated these six Core Competencies as imperative for all training and practicing physicians. They are the standard by which all patient care will be judged. The Patient Care and Procedural Skills competency speaks directly to how providers should interact directly with the patients under their care. Keeping these skills as a priority and understanding the unavoidable impact they have on the care and treatment of patients is tantamount to providing quality healthcare.
Read more about the six ACGME Core Competencies