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Competency Requirements

M E M O R A N D U M
TO: Designated Institutional Officials
Institutional Administrators
Members of Institutional GMECs
FROM: Cynthia Taradejna, Executive Director
Institutional Review Committee
(312) 464-4685
E-mail: cat@acgme.org
RE: ACGME GENERAL COMPETENCY REQUIREMENTS EFFECTIVE JULY 1, 2002
DATE: February 6, 2002


Three years ago, the ACGME launched its Outcome Project and through an extensive review process, identified six general competencies for resident development. As you are aware, these six competencies have been incorporated into the Institutional Requirements and all sets of Program Requirements for implementation on July 1, 2002. With the implementation date just a few months away, Designated Institutional Officials (DIOs) must ensure that they and their program directors are sufficiently prepared to meet these new requirements. This memorandum serves to familiarize DIOs and Graduate Medical Education Committees with the steps involved in the process of implementation prior to July 1, 2002.

In the Institutional Requirements, the standards that address the general competencies have been added to the responsibilities of the GMEC (I.B.3.i). They replace the former requirements that addressed specific core curriculum topics. The definitions of the six competencies are listed in section II.B, and new requirements have been added to the internal review process in section I.B.3.e, and f. A copy of these requirements may be found on the ACGME Web site under "Institutional Review" in the table of contents, "Institutional Requirements", "Approved But Not Currently in Effect 7/2002."

The first step in the implementation plan for institutions is to begin to update the written protocol for the internal review process. A COPY OF YOUR REVISED WRITTEN PROTOCOL IS TO BE SUBMITTED TO THE ACGME BEFORE JULY 1, 2002. For clarification, there are two basic requirements regarding the general competencies that should be assessed during the internal review in the initial stages and they are:

  1. Assurance that each program has developed its curriculum that incorporates the teaching of the competencies as specified in the specialty's Program Requirements. The program's curriculum should include the goals and objectives based on the competencies because without them, effective evaluation tools cannot be constructed.

  2. Assurance that each program is developing and using an assortment of evaluation tools to assess a resident's competence in the various areas.

After programs have had sufficient time to develop steps 1 and 2, the internal review should then include

  1. Evidence of a program's development and use of dependable measures to assess resident competencies. (This part cannot be implemented until a program has used its evaluation tools over a period of time to determine whether or not they are dependable.)

  2. Evidence of a program's effectiveness in linking educational outcomes with program improvement. (This part cannot be implemented until the program has had sufficient time to analyze its educational outcomes to determine what needs improvement.)

To provide assistance with your revisions, I am attaching language that may be incorporated into your written protocol (number 1.a-d) to ensure that all of the Institutional Requirements regarding the competencies are addressed. In addition, I am providing an example of a table that may be used to gather information from the programs on the types of evaluation tools they have selected.

Please note that internal reviews that are conducted after July 1, 2002 are expected to provide an assessment of a program's progress in adding the competencies to its curriculum, development of goals and objectives for teaching the competencies, and the types of evaluation tools that are being used. Evidence will be sought in the internal review reports that the programs are addressing these areas.


A word of caution to DIOs: It has been rumored that some program directors have developed a "wait-and-see" attitude with respect to implementing their specific Program Requirements addressing the general competencies. Program directors should be reminded that now is the time to begin to implement the initial steps of the ACGME's Outcome Project to avoid unnecessary citations and possible adverse actions. Program directors seeking additional help should review the ACGME Web site under "Competencies and Outcomes Assessment," which contains an increasing wealth of information, or contact their ACGME Executive Director for the appropriate Residency Review Committee for assistance.

As a reminder, the Outcome Project is to be phased in over a number of years but in the first phase, which is between now and July 1, 2002, program directors are expected to

  1. define specific objectives for residents to demonstrate learning in several of the competencies;

  2. review current approaches to evaluation of residents learning and develop improved assessment tools; and,

  3. begin integrating the teaching and learning of competencies into residents' didactic and clinical educational experiences as needed to ensure learning opportunities.

Many thanks to the DIOs who have already provided their revised written protocols and the program directors who have progressed to outcomes assessment. The ACGME and Institutional Review Committee look forward to the successful implementation of the Outcome Project in your institutions.