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Let's get right to the core!
by: LAWRENCE M. SHUER
One of our most important activities at Stanford Hospital & Clinics is the training of interns, residents and fellows in various disciplines of medicine. The opportunity to help train the next generation of physicians is one of the attractions for many members of our medical staff.
Maintaining these residency and fellowship programs is no easy task. Individual programs and the institution as a whole are held to standards set by the Accreditation Council for Graduate Medical Education and the Residency Review Committees to maintain certification. Each of our programs has periodic reviews by the designated RRC at which a site visitor interviews faculty, trainees and administrative personnel to judge whether the program is meeting the "general requirements" and "special requirements" necessary for maintaining accreditation.
Programs that are in full compliance and receive a favorable RRC review may receive full accreditation for five years before the next review is required. Conversely, troubled programs may be placed on probation that requires another review to be conducted much sooner - sometimes as little as one year later.
Our institution undergoes a site visit as well. We are evaluated as to our suitability for providing training programs and our ability to meet the requirements for maintaining an appropriate training environment for residents. We are charged with continuously looking at individual programs and ensuring that they live up to their special requirements as well.
Each of the special requirements and the general requirements can be found on the ACGME Web site (http://www.acgme.org). Because the requirements and standards undergo changes from year to year, this is a moving target.
We have a Graduate Medical Education committee that has oversight for our training programs. The committee is made up of the residency program directors as well as six resident members. Ann Dohn is the director of graduate medical education and she coordinates all of our activities in this endeavor. Ann has done an outstanding job of keeping the institution in full accreditation. Our last visit was in February 1997 at which point we received full accreditation, with the next review scheduled for October of this year. Ann keeps the program directors updated on changes in the general requirements for the institution as well as for the individual programs.
One of the new issues to come down the pike for us is the "Core Competencies" and how we implement the training and assessment of them in all residency programs. This is the first step in the ACGME's long-term effort to emphasize educational outcome assessment in the accreditation process.
In February 1999, the ACGME endorsed general competencies for residents in the areas of: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice. These areas and the competency requirements are shown in the accompanying chart. Many of us would like to believe that all six areas have been implicit in our training of residents down through time. However, the ACGME and RRCs want us to formalize this in writing, describing how we train residents and fellows in these core areas and how we will measure whether we are succeeding. They have asked us to define the specific knowledge skills and attitudes required, and provide the educational experiences needed for the residents to demonstrate these competencies.
I do not believe the challenge will be in providing opportunities for residents to learn or master these competencies. The difficulty will be in developing tools to assess how well residents perform in these areas. We must be able to demonstrate dependable measures of these competencies, and the residents will need regular, timely feedback regarding these issues.
All of our training programs will develop service-specific plans for implementing the training and assessment of these core competencies. Should you have suggestions or ideas on how best to accomplish this, please contact either Ann Dohn at adohn1@stanford.edu or me at
