The ACGME is a bit of a nag. Established in 1981, the Accreditation Council for Graduate Medical Education is charged with regulating residencies, basically. It was formed in response to some problems with variability in the quality of residency programs and lack of uniform standards. This organization dithered and muttered, studied and interviewed, did surveys and wrote memos, and in 1999 came up with six “Core Competencies”, or domains of clinical competence that all graduating residents should have. Here they are:
Patient Care: Identify, respect, and care about patients’ differences, values, preferences, and expressed needs; listen to, clearly inform, communicate with and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.
Medical Knowledge: Established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social behavioral) sciences and the application of knowledge to patient care.
Practice-Based Learning and Improvement: Involves investigation and evaluation of one’s own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.
Interpersonal and Communication Skills: That result in effective information exchange and teaming with patients, their families and other health professionals.
Professionalism: Commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.
Systems-Based Practice: Actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
The dithering continued, and 10 years later the ACGME started coming up with rules about how residency programs could get their residents to have all these competencies. Residencies had to show they were teaching their residents this stuff in order to be accredited, i.e., in order to be a program anyone would want to go to. Now the great minds in graduate medical education have decided they need a new accreditation system, which they called, in a recent Academic Medicine article: Next Accreditation System (NAS for short. Catchy right?). Always eager to reinvent the wheel, the ACGME did another survey and found that “program directors have expressed concern regarding the skill set among interns from different medical schools.” Here are the four skills that these program directors agreed were most important: (http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2014&issue=03000&article=)
Professionalism – essentially bioethics
Communication and interpersonal skills – fancy words for being able to function in a team
Practice-based learning and improvement – application of evidence in practice – Evidence Based Medicine
Systems-based practice – patient safety mostly. Plus how to work the system effectively
Yep. Same skills as the ones they found in 1999. But take a closer look at these competencies. These are not medical competencies. They are life competencies. You could apply this same skill set to any profession or business. None of the skills listed, with the possible exception of evidence based medicine, is specific to physicians. Just out of curiosity, I looked around the Harvard Business School website and found that, indeed, the business world has core competencies too. Here they are: (http://www.cbsnews.com/news/5-personal-core-competencies-for-the-real-business-world/)
Harvard Graduate School of Education professor Helen Haste identifies these five competencies for the new millennium:
- Managing Ambiguity
- Agency and Responsibility
- Finding and Sustaining Community
- Managing Emotion
- Managing Technological Change
Hmm. Let’s see. Managing ambiguity. As in, “Identify, respect, and care about patients’ differences, values, preferences, and expressed needs; listen to, clearly inform, communicate with and educate patients; share decision making and management.”? Agency and Responsibility. Like “Commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.”? Finding and sustaining community. Or, for instance, “…effective information exchange and teaming with patients, their families and other health professionals.” Managing emotion. Well, you business people are on your own there. Managing Technological change. EMR anyone?
So these are the sorts of things senior doctors thought it most important for junior doctors to know. Not medicine. Not technical skills. Not drug dosages or differential diagnoses. Not chemistry or physics. Life skills. Do we choose our medical students based on what’s most important to the senior doctors? No. We choose them based on their grades in science. Are there any questions on the MCAT about how to communicate within a team? No. Do we really promote listening, communicating, understanding patient’s values, and educating them? Not with all our intern’s noses in computers. The ACGME core competencies, and the Next Accreditation System, are just words and regulations that have to be checked off. They mean nothing.