ACGME Competencies
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In keeping with the expectation that the residency program require its residents to obtain competencies in the six defined areas of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, we have begun the design and implementation of a new approach to training and evaluation. The approach and evaluation method used for each of the six competencies is outlined below:
Patient Care
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
Professionalism
Systems-Based Practice
PATIENT CARE
It is the expressed goal of the program that each resident will be able to:
- Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
- Gather essential and accurate information about their patients
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
- Develop and carry out patient management plans
- Counsel and educate patients and their families
- Use information technology to support patient care decisions and patient education
- Perform competently all medical and invasive procedures considered essential for the area of practice
- Provide health care services aimed at preventing health problems or maintaining health
- Work with health care professionals, including those from other disciplines, to provide patient-focused care
Training primarily is directly taught in the delivery of patient care by talented and dedicated faculty and colleagues. Role modeling is felt by the department to be an essential component of the educational process. Residents work side by side with attending physicians in the delivery of care. Evaluation of the resident's performance takes place on many levels but it is felt that the most important is directly observed interactions with the patient followed immediately by constructive feedback. End of rotation evaluation is performed and given to the resident by the attending of record. Specific emphasis is placed upon professionalism and humanism with specific evaluations of each required. Evaluation is more formally performed in the form of the mini-CEX as developed by the ABIM and which is required four times yearly by each resident in the program.
MEDICAL KNOWLEDGE
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to:
- Demonstrate an investigatory and analytic thinking approach to clinical situations
- Know and apply the basic and clinically supportive sciences which are appropriate to their discipline
Resident noon conferences are held Monday through Thursday each week and provide didactic instruction in the knowledge content expected of a practicing internist. The conferences are interactive and case-based. The residents are responsible for researching topics and presenting these to their colleagues and members of the faculty in this setting as well. Additionally, each resident is required to prepare and present two Medical Grand Rounds during their three years of residency training. Attending led teaching rounds are a formal part of every clinical rotation and are held on a regularly scheduled basis. Dr. Allan Brett leads one-to-two discussions monthly based on material from Journal Watch, for which he is the Editor-in-Chief. The subspecialty rotation attendings are responsible for ensuring that the core material for their subspecialty is presented to each rotating resident and that the resident is provided with an up-to-date reading list. Evaluation of the resident's knowledge base is performed on several fronts including one-on-one evaluation, participation in conferences, end of rotation testing and the annually administered In-Service Training Examination. Residents felt to have an inadequate knowledge base are individually counseled with specific programs designed to improve deficiencies.
PRACTICE-BASED LEARNING AND IMPROVEMENT
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:
- Analyze practice experience and perform practice-based improvement activities using a systematic methodology
- Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
- Obtain and use information about their own population of patients and the larger population from which their patients are drawn
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
- Use information technology to manage information, access on-line medical information; and support their own education
- Facilitate the learning of students and other health care professionals
Each resident will be required to participate in at least two quality improvement programs. One of these occurs during their geriatric rotation and is already in place. The second (in development) will occur during the PGY-1 year rotation in ambulatory medicine. Additionally, the program conducts a QA program in the ambulatory setting and the in-patient setting.
Each month, several noon conferences are devoted to keeping up-to-date with the medical literature. Specific skills in literature interpretation are put to use as faculty lead formal, monthly discussions in Evidence Based Medicine. The focus of these sessions is the application of these skills to patient care. Every resident in the program is provided with instruction on the use of information technology to manage information. The medical resources provided include Journal Watch®, Up to Date®, MDConsult®, ACP Journal Club®, the Cochrane Library and, of course, Medline. Access to all of these is available from home, the clinic and any computer in the hospital.
Evaluation of Practice-Based Learning and Improvement is primarily performed based upon the QA projects required of the residents as well as evaluation of the performance of the residents in presentation of article reviews and application of information in the care of their respective patients.
INTERPERSONAL AND COMMUNICATION SKILLS
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to:
- Create and sustain a therapeutic and ethically sound relationship with patients
- Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
- Work effectively with others as a member or leader of a health care team or other professional group
The instruction of the residents in interpersonal and communication skills occurs primarily in the same manner as that covered under the patient care section. Evaluation is in a similar manner as well. It is strongly felt that role modeling by effective senior clinicians and feedback by the same physicians is essential in the development and maintenance of these skills in young physicians.
PROFESSIONALISM
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
- Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development
- Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
- Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities
In addition to role modeling, specific sessions are held dealing with ethics and professionalism. We are blessed as a program in having several faculty members who are also in the department of bioethics at USC. Monthly sessions dealing with specific patient-related scenarios are held which require resident participation and brain-storming. Evaluation in this important area is performed primarily at the level of attending to resident and vice-versa. We are soon to begin implementation of a 360-degree evaluation program wherein the residents will be evaluated by fellow residents, nurses, social workers, and patients.
SYSTEMS-BASED PRACTICE
Residents must 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. Residents are expected to:
- Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice
- Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
- Practice cost-effective health care and resource allocation that does not compromise quality of care
- Advocate for quality patient care and assist patients in dealing with system complexities
- Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance
Specific instruction in consultation is provided to the residents in many sub-specialty and general medicine rotations. Residents work side-by-side with ancillary personnel in the delivery of care. They are formally instructed in the roles of social workers, case managers, and other health care managers. During the PGY-1 rotation in Ambulatory Medicine, the residents rotate with physical therapists, occupational therapists, and speech therapists to see directly the important role that these clinicians play in the care of our mutual patients.
In the current environment of careful attention to the delivery of cost-effective health care, residents are consistently asked to provide justification for test ordering. This is felt to be such an important part of their training that they are formally evaluated monthly as to how they address such issues. The soon to be implemented 360-degree evaluation will also provide insight into the resident's performance in this area.