Educational milestone development in the first 7 specialties to enter the next accreditation system.

Background: The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project introduced 6 general competencies relevant to medical practice but fell short of its goal to create a robust assessment system that would allow program accreditation based on outcomes. In response, the ACGME, the specialty boards, and other stakeholders collaborated to develop educational milestones, observable steps in residents' professional development that describe progress from entry to graduation and beyond.

Objectives: We summarize the development of the milestones, focusing on 7 specialties, moving to the next accreditation system in July 2013, and offer evidence of their validity.

Playing with curricular milestones in the educational sandbox: Q-sort results from an internal medicine educational collaborative.

Purpose: In competency-based medical education, the focus of assessment is on learner demonstration of predefined outcomes or competencies. One strategy being used in internal medicine (IM) is applying curricular milestones to assessment and reporting milestones to competence determination. The authors report a practical method for identifying sets of curricular milestones for assessment of a landmark, or a point where a resident can be entrusted with increased responsibility.

The development of the emergency medicine milestones.

The Accreditation Council for Graduate Medical Education (ACGME) has outlined its "Next Accreditation System" (NAS) that will focus on resident and residency outcome measurements. Emergency medicine (EM) is one of seven specialties that will implement the NAS beginning July 2013. All other specialties will follow in July 2014.

The role of assessment in competency-based medical education.

Competency-based medical education (CBME), by definition, necessitates a robust and multifaceted assessment system. Assessment and the judgments or evaluations that arise from it are important at the level of the trainee, the program, and the public. When designing an assessment system for CBME, medical education leaders must attend to the context of the multiple settings where clinical training occurs.

Perspectives on competency-based medical education from the learning sciences.

A central component of competency-based medical education is a framework of higher-order and more fundamental competencies whose purpose is to focus instruction and learning. In the language of the learning sciences, many of these competencies are complex cognitive-perceptual or cognitive-motor skills. Competency-based medical education has been criticized for being reductionistic, that is, for focusing on atomistic skills and failing to capture the essence of professional activities as manifested by complex, integrated capabilities.

Competency-based medical education in postgraduate medical education.

With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from a time- and process-based system to a competency-based training framework. Implementing competency-based training in postgraduate medical education poses many challenges but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Making this transition requires change at virtually all levels of postgraduate training.

Competency-based medical education: theory to practice.

Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership - the International CBME Collaborators - to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals.

Advancing resident assessment in graduate medical education.

Background: The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice.

Intervention: The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007-2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance.

The ACGME outcome project: retrospective and prospective.

Background: The Accreditation Council for Graduate Medical Education began an initiative in 1998 to improve resident physicians' ability to provide quality patient care and to work effectively in current and evolving healthcare delivery systems.

Aims: This initiative, called the Outcome Project, seeks changes in residency programs that focus education on the competency domains, enhance assessment of resident performance and increase utilization of educational outcomes for improving residents' education. Increased emphasis on educational outcome measures in accreditation is another important goal.

Using patient care quality measures to assess educational outcomes.

Objectives: To report the results of a project designed to develop and implement a prototype methodology for identifying candidate patient care quality measures for potential use in assessing the outcomes and effectiveness of graduate medical education in emergency medicine.

Methods: A workgroup composed of experts in emergency medicine residency education and patient care quality measurement was convened. Workgroup members performed a modified Delphi process that included iterative review of potential measures; individual expert rating of the measures on four dimensions, including measures quality of care and educational effectiveness; development of consensus on measures to be retained; external stakeholder rating of measures followed by a final workgroup review; and a post hoc stratification of measures.

Assessing practice-based learning and improvement.

Background: Practice-based learning and improvement (PBLI) is 1 of 6 general competencies expected of physicians who graduate from an accredited residency education program in the United States and is an anticipated requirement for those who wish to maintain certification by the member boards of the American Board of Medical Specialties. This article describes methods used to assess PBLI.

Summary: Six electronic databases were searched using several search terms pertaining to PBLI.

Graduates' perceptions of their clinical competencies in allergy and immunology: results of a survey.

Purpose: The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have identified six areas of general competency. This study surveyed graduates of allergy and immunology training programs about their perceived clinical competency and the adequacy of their subspecialty training.

Method: In August 2000 and May 2001, a questionnaire was mailed to 373 physicians who had completed a fellowship in allergy and immunology in the United States between 1995 and 2001.

Assessing the ACGME general competencies: general considerations and assessment methods.

The Accreditation Council for Graduate Medical Education's (ACGME's) general competency and outcome assessment initiative (i.e., the ACGME Outcome Project) is an effort to enhance residency education and accreditation effectiveness by increasing emphasis on educational outcomes.