The Competencies

Erica S. Friedman MD

Medicine: A Competency-Based Companion is part of a series for medical students and residents designed to guide you through an expert clinician’s thought process when encountering a particular patient or clinical problem; it uses a competency-based framework to approach the problem.

Competencies are an educational paradigm helpful in clarifying for the teacher and the learner the outcomes-based performance expectations. Competencies identify behaviors as opposed to knowledge or skills, and they require synthesis and integration of information to achieve the outcome. They define what physicians must be able to achieve for effective practice and to meet the needs of their patients. Defining competencies also helps guide curriculum development, teaching, learning, and assessment.

Medical education has experienced a major paradigm shift from structure- and process-based to competency-based education and measurement of outcomes. Structure- and process-based education focuses on knowledge acquisition in a fixed time frame, has the teacher responsible for the content and dissemination of knowledge, and, in general, evaluates success by defining the norm and failing anyone whose performance falls more than two standard deviations below the mean. In contrast, competency-based education focuses on knowledge application, and the learner is the driving force for the process, equally responsible with the teacher for the content. It utilizes multiple evaluations in real time and, in general, applies a standard for developing the criteria for competence. It allows and expects variability in time for mastery of these competencies.

In the latter part of the 20th century, the public expectation for accountability and responsibility around physician competency became a driving force for the Accreditation Council for Graduate Medical Education (ACGME) to establish the competencies. The ACGME shifted its focus from a structure and process system of graduate medical education to one that is outcomes-based and since 1999 has required all residents in training to achieve competence in six broad domains.

The ACGME’s six core competencies are as follows:

1. Patient Care.

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