The Accreditation Council for Graduate Medical Education (ACGME) is responsible for instituting educational standards and requirements for Graduate Medical Education (GME) and training programs across the United States. ACGME selected and endorsed a set of six core competencies to help establish the basic skills and attributes that practicing physicians should be able to demonstrate in order to graduate and excel in the field of medicine. The competencies were first adopted in 1999; later, the American Board of Medical Specialties (ABMS) integrated them into the Maintenance of Certification (MOC) program.
The ACGME Core Competencies provide a framework for educational programs, ensuring that medical training is focused on skills that are directly relevant to patient care and preparing residents for a successful medical practice. In Part 1 of this blog series, we listed the ACGME Core Competencies and described Entrustable Professional Activities (EPAs) and Milestones. In each successive post, we will choose a specific ACGME Core Competency and delve into it further.
What Are the ACGME Core Competencies?
ACGME Core Competencies measure a physician’s ability to:
- Administer a high level of care to diagnose and treat illness
- Offer and implement strategies to continuously improve patient health and wellness
- Offer advice and resources to prevent disease in patients
- Provide not only physical treatment, but also emotional support as the physician cares for patients and interacts with patients’ families and support systems
The six ACGME Core Competencies are: Practice-Based Learning and Improvement, Patient Care and Procedural Skills, Systems-Based Practice, Medical Knowledge, Interpersonal and Communication Skills, and Professionalism. In this article, we will focus on the ACGME Core Competency of Practice-Based Learning and Improvement (PBLI) and its subcompetencies.
Practice-Based Learning and Improvement
The medical field is constantly evolving. Through patient care, the practicing physician is exposed to new information and innovations daily: the heretofore unknown symptom, the fresh perspective, the brand-new study. Achieving initial certification and recertification through a combination of continuing education opportunities and PBLI activities can have great benefit for physicians. Practice-based learning is efficient, allowing the busy physician to gain knowledge in the midst of daily medical practice. Practice-based improvement is also highly effective, as physicians apply that knowledge to real-life situations occurring in daily medical practice.
The ACGME Core Competency of Practice-Based Learning and Improvement shows the ability to comprehend relevant information and a commitment to lifelong learning. Demonstration of competency in PBLI occurs when a resident, and later, a physician, displays the ability to:
- investigate and evaluate patient care practices
- appraise and assimilate scientific evidence, and
- improve the practice of medicine.
The ACGME Core Competencies: Subcompetencies for Practice-Based Learning and Improvement
The PBLI subcompetencies are defined as: (1) locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems, (2) demonstrate self-directed learning, and (3) improve systems in which the physician provides care. The foundational aspects of this core competency are consistent across the board, although medical education programs may differ in how they present the knowledge and which skills they choose to focus on when training physicians. Let’s take it step by step.
Investigate and Evaluate Patient Care
In order to meet requirements for the ACGME Core Competency of Practice-Based Learning and Improvement, a resident or physician must demonstrate an ability to investigate and evaluate patient care practices by gathering and analyzing patient information. This includes identifying personal and professional strengths and weaknesses through self-reflection. Understanding limits, then seeking out the education and knowledge to continually push past those limits. Setting goals for lifelong learning and using the resources available to continuously improve the daily practice of medicine.
How do you assess your own level of competency in Practice-Based Learning and Improvement? To maintain this ACGME Core Competency, physicians must develop or employ a systematic method to analyze and understand their personal practice experience. Journaling, learning from CME programs, MOC-related activities, and assessments can all be helpful in allowing a physician to identify areas of proficiency and areas for improvement.
Appraise and Assimilate Scientific Data
The second piece of the ACGME Core Competency in PBLI is that residents must learn to appraise and assimilate scientific evidence. In their daily practice of medicine, physicians must have the discernment, born of continuing education and knowledge of scientific studies and innovations, to balance unique human experience with scientific evidence. To demonstrate this core competency, physicians must be able to access and review scientific information in medical journals and published clinical studies and apply this information to each patient’s needs. They must exhibit the ability to draw relevant conclusions from this research, using their knowledge of study design and statistics in order to determine whether the information should influence diagnosis and treatment. And finally, physicians must be able to combine scientific data with observations about the patient population in their own practice compared with the population as a whole.
Apply Continuous Improvement to the Practice of Medicine
The third and final element for ACGME Core Competency in PBLI is for residents to demonstrate skills in and a commitment to improving the practice of medicine. In this way, a physician is not only a student and lifelong learner, but an educator who shares that learning. In this role, physicians must educate patients, patients’ families, practice staff, and even fellow doctors and health professionals (particularly in the case of physicians who supervise medical residency programs or hold positions in colleges, universities, and teaching hospitals.)
Facilitating learning allows physicians to improve the practice of medicine by acting as an ambassador for the medical field, representing medicine in the world and passing on the knowledge gained over years of study. Residents must also exhibit the capability to apply that knowledge to daily medical practice. By employing quality improvement methods to systematically evaluate their own practice, physicians can implement changes for continuous improvement of that practice. Residents and physicians must also be open to constructive feedback from evaluators, faculty, and patients, as well as other members of the health care team including specialists, nurses, and medical assistants. Such feedback allows physicians to incorporate outside assessment into daily medical practice to enhance the quality of patient care.
The ACGME Core Competencies aim to spur a lifelong-learning pattern for physicians and continuous improvement for medical schools. The ACGME Core Competencies allow physicians and residents to pinpoint and hone the necessary skills to maintain a strong, successful medical practice. The ACGME Core Competency of PBLI is an essential skill set for residents and physicians, helping them develop the mindset of lifelong learning and continuous improvement through real-world observation, self-reflection, scientific data, and the give and take of teaching and learning. PBLI prompts continuous improvement of medical practice and translates into better medical instruction, more capable, qualified physicians, and significantly improved patient care.