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A Basic Guide to the ACGME General Competencies. Adapted from the CORD website by: Phil Levy, M.D. Gloria Kuhn, D.O. Bob Wahl, M.D. Wayne State University School of Medicine. Introduction Responsibility of the Program. Teach the ACGME General Competencies

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a basic guide to the acgme general competencies

A Basic Guide to the ACGME General Competencies

Adapted from the CORD website by:

Phil Levy, M.D. Gloria Kuhn, D.O.

Bob Wahl, M.D.

Wayne State University School of Medicine

introduction responsibility of the program
IntroductionResponsibility of the Program
  • Teach the ACGME General Competencies
  • Assess the resident’s achievement of competence in each of the Core Competencies before graduation
  • Faculty development
introduction responsibility of the faculty
IntroductionResponsibility of the Faculty
  • Know what the Core Competencies are
  • Commit (be prepared) to teach them
  • Commit (be prepared) to assess a resident’s progression to competency in each of them
faculty development
Faculty Development

Information pertinent to your knowledge and understanding of the core competencies will be provided to you via:

  • E-mail
  • Staff meetings
  • Faculty meetings
  • Distance learning
gaining medical knowledge
Gaining Medical knowledge
  • Clinical Experience : Most important aspect of training
    • Bedside teaching and learning transforms medical students into physicians
slides in this series
Slides in this Series
  • Define the competencies
  • Discuss meaning of the competencies
  • Faculty will be asked to attest that they have read the material, understand it, and commit to teach the competencies
request faculty
Request Faculty
  • List the ACGME Core Competencies
  • Sign attestation
  • Return to Sandra Garling
    • E-mail (sgarling@med.wayne.edu)
    • Fax (745-3653 attn Sandra Garling)
    • Hard copy
what are the core competencies
What Are the Core Competencies ?
  • Six approved by ACGME in February 1999
    • Patient Care
    • Medical Knowledge
    • Practice-Based Learning and Improvement
    • Interpersonal and Communication Skills
    • Professionalism
    • Systems-Based Practice
definitions
Definitions
  • ACGME provided the general language
  • Each specialty provided the detailed definitions
  • The Council of EM Residency Directors (CORD) held a series of consensus conferences to define for our specialty
    • Intellectual and procedural skills
    • Behaviors
why adopt a competency based model
Why Adopt A Competency Based Model?
  • Creates objective criteria for evaluation
    • Core competencies
  • Holds programs/educators accountable
  • Demonstrates effectiveness of efforts
  • Holds residents accountable
current reality
Current Reality
  • Programs must demonstrate provision of an educational experience that will ensure proficiency for all graduates in the core competencies
  • Programs must assess residents
  • Programs will be assessed
core competencies
Core Competencies
  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice
definition of competency patient care 1
Definition of Competency Patient Care 1
  • Provision of timely, effective, appropriate and compassionate patient care

1 King et al. AEM 2002;9:1227-1235

meaning patient care 1
Meaning Patient Care 1

The Resident:

  • Gathers accurate, essential information using all available sources
  • Integrates diagnostic information to form an appropriate differential diagnosis

1 King et al. AEM 2002;9:1227-1235

meaning patient care 115
Meaning Patient Care 1
  • Implements an effective management plan
      • Including treatment, consultation, disposition and pt. education
  • Resident has the capacity to perform essential
    • diagnostic, and
    • therapeutic procedures

1 King et al. AEM 2002;9:1227-1235

meaning patient care 116
Meaning Patient Care 1

Simultaneously

  • Prioritize and stabilize
    • multiple patients
  • Perform other responsibilities

1 King et al. AEM 2002;9:1227-1235

definition of competency medical knowledge 1
Definition of CompetencyMedical Knowledge 1
  • Use medical knowledge for clinical problem solving and decision-making
  • Identify life-threatening conditions
  • Formulate an appropriate differential diagnosis

1Wagner MJ AEM 2002, 9:1236–1241

meaning medical knowledge 1
MeaningMedical Knowledge 1

Specific immediate recall of information for care of critical patients

Understand use of medical resources for immediate care

Apply information to undifferentiated patient presentations

1Wagner MJ AEM 2002, 9:1236–1241

Wagner MJ AEM 2002, 9:1236–1241

gaining medical knowledge19
Gaining Medical Knowledge
  • Didactic knowledge
    • Classroom
    • Independent study

Bedside learning

definition of competency practice based learning and improvement 1
Definition of CompetencyPractice-Based Learning and Improvement 1
  • Understand patient care practices and assimilate necessary components for improvement

1 Hayden et al. AEM 2002;9:1242-1248

meaning practice based learning and improvement 1
MeaningPractice-Based Learning and Improvement 1
  • Use scientific evidence related to patient’s health problems and the larger population from which they are drawn
  • Scrutinize and critically interpret medical literature

1 Hayden et al. AEM 2002;9:1242-1248

meaning practice based learning and improvement 122
MeaningPractice-Based Learning and Improvement 1
  • Able to utilize information technology to effect patient care and education
  • Able to facilitate the education of colleagues and students

1 Hayden et al. AEM 2002;9:1242-1248

definition of competency interpersonal and communication skills 1
Definition of CompetencyInterpersonal and Communication Skills 1
  • Able to conduct an effective information exchange with patients, their families and medical colleagues

1 Hobgood et al. AEM 2002;9:1257-1269

meaning interpersonal and communication skills 1
Meaning Interpersonal and Communication Skills 1
  • Appropriate language
  • Ability to read body language of patient/families
  • Find an interpreter
  • Ask for questions
  • Repeat information if needed
  • Patience

1 Hobgood et al. AEM 2002;9:1257-1269

meaning interpersonal and communication skills 125
MeaningInterpersonal and Communication Skills 1
  • Capable of creating a therapeutic relationship
    • Discuss condition with appropriate empathy
  • Demonstrate respect for cultural, ethnic, gender and age-related differences

1 Hobgood et al. AEM 2002;9:1257-1269

meaning interpersonal and communication skills 126
Meaning Interpersonal and Communication Skills 1
  • Use of comprehensible written and spoken language
  • Able to interact in an adaptable manner

1 Hobgood et al. AEM 2002;9:1257-1269

meaning interpersonal and communication skills 127
Meaning Interpersonal and Communication Skills 1
  • Able to negotiate and resolve conflict
  • Can function as an effective team member and leader
  • Capable of soliciting and implementing feedback

1 Hobgood et al. AEM 2002;9:1257-1269

definition of competency professionalism 1
Definition of CompetencyProfessionalism1
  • Arrives on time, ready to work
  • Maintains a proper appearance
    • Inoffensive dress and appropriate cleanliness

1 Larkin et al. AEM 2002;9:1249-1256

meaning professionalism 1
Meaning Professionalism 1
  • Respectfully interacts with patients, family, colleagues and the health care team
    • Proper introduction and manner of speech

1 Larkin et al. AEM 2002;9:1249-1256

meaning professionalism 130
Meaning Professionalism 1
  • Demonstrates sensitivity to medical and emotional needs of patient
  • Appropriate use of humor/language
  • Maintains composure under stress

1 Larkin et al. AEM 2002;9:1249-1256

meaning professionalism 131
Meaning Professionalism 1
  • Willingly sees patients throughout shift
  • Conscientious transfer of care (sign-out)
  • Punctual completion of medical records
  • Equitable in recruitment and peer review

1 Larkin et al. AEM 2002;9:1249-1256

meaning professionalism 132
Meaning Professionalism 1
  • Demonstrates accountability, responsibility, and integrity !!

1 Larkin et al. AEM 2002;9:1249-1256

definition of competency systems based practice 1
Definition of CompetencySystems-Based Practice 1
  • Capacity to understand, access, and effectively utilize the resources of a given health care system to enable the provision of optimal emergency care

1 Dyne et al. AEM 2002;9:1270-1277

means correctly using institution s resources
Computer system

Social services

Free clinics

Our clinics

Pharmacy

Radiology

Special Procedures

Vascular laboratory

Stroke team

Cardio Team One

Means Correctly Using Institution’s Resources
means correctly using external resources 1
Means Correctly Using External Resources 1
  • Ability to apply a working knowledge of different health care practice models and delivery systems to the treatment of an individual patient

1 Dyne et al. AEM 2002;9:1270-1277

meaning
Meaning
  • HMOs
  • PPOs
  • Medicare
  • Medicaid
  • Prescriptions
  • Dental
  • Extended care
competency objectives systems based practice 1
Competency Objectives: Systems-Based Practice 1
  • Practice cost-effective health care and resource allocation that does not compromise quality care

1 Dyne et al. AEM 2002;9:1270-1277

meaning systems based practice 1
Meaning Systems-Based Practice 1
  • Advocate for and facilitate patients’ advancement through the health care system

1 Dyne et al. AEM 2002;9:1270-1277

teaching
Teaching

Modeling of behavior

Bedside teaching

Discussion

Feedback

Mentoring

Didactic instruction

teaching40
Teaching
  • Knowing the General Competencies
  • Making sure the residents’ practice and performance demonstrates attainment of the competencies
teaching41
Teaching
  • Helping residents to improve in performance of the competencies
  • Evaluating junior and senior residents progression in attaining ability to practice the competencies
  • Evaluating the graduating residents’ attainment of the competencies
methods of assessment global ratings of performance
Methods of AssessmentGlobal Ratings of Performance
  • Description:
    • Rater judges general categories of ability
    • Ratings completed retrospectively based on general impressions collected over time
    • Rating scales
  • Use
    • End of rotation/summary assessments
    • Numeric ratings plus comments
assessment
Assessment
  • Staff/faculty meeting
    • Verbal discussion
    • Specific behaviors
    • Specific examples
  • Written documentation
  • Improvement
  • Correction for future improvement
faculty level of training
FacultyLevel of training

Behavior

Problem solving

faculty level of training45
FacultyLevel of training
  • Behavior
    • Manage time
    • Interact with patients
    • Courtesy
    • Leadership
ultimately
Ultimately

Are they progressing in mastering the competencies?

If not, what are the problems?

Upon graduation, have they demonstrated proficiency/competency in the Core Competencies?

summary
Summary

Bulk of teaching by clinical attendings

Modeling behavior

Verbal instruction

Discussion

assessment48
Assessment

Bulk of assessment /evaluation by clinical attendings

evaluation of resident performance
Evaluation of Resident Performance
  • On-line
    • New Innovations
  • Hard copy
    • Forms filled out and returned to the residency leadership team
summary50
Summary
  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice