Glossary

Accreditation: Accreditation refers to the recognition of educational programs through review against particular standards. In the United States, accreditation is voluntarily sought by institutions and is conferred by non-governmental bodies. There are two types of educational accreditation: specialized and institutional. The ACGME is a specialized body, accrediting graduate medical education programs within an institution. Accreditation of graduate medical education training programs by the ACGME is accomplished through a peer review process and is based upon established standards and guidelines. The ACGME does not accredit institutions, but rather, recognizes them to sponsor GME programs.

ACGME Outcome Project: The two major goals of the ACGME Outcome Project are to ensure: 1) that residency program educational content is aligned with the changing needs of the health care system; and, 2) that residency programs have outcome assessment systems that provide sound measures of the programs' educational effectiveness. To accomplish these goals, the ACGME has identified the six general competencies, grounded in a national consensus on what residents should know and be able to do. Language regarding the general competencies and increased emphasis on outcomes assessment has been added by the Residency Review Committees and the Institutional Review Committee to all core specialty program requirements and to the Institutional Requirements. Eventually, over the long term, changes to the accreditation process will reflect the shift to outcomes assessment.

Assessment: In his book, Classroom Assessment, (Airasian PW. Classroom assessment (3rd ed.). New York: McGraw-Hill, 1997), Airasian defines assessment as the "process of collecting, synthesizing, and interpreting information to aid decision-making". (see further, "Considerations for Selecting and Implementing Assessment Approaches/Instruments.")

Certification: The intent of the certification of physicians is to provide assurance to the public that a physician specialist certified by a Member Board of the American Board of Medical Specialties (ABMS) has successfully completed an approved educational program and an evaluation process which includes an examination designed to assess the knowledge, skills, and experience required to provide quality patient care in that specialty (taken from the ABMS Annual Report and Reference Handbook). Physicians who are successful in achieving certification are called diplomates of the respective specialty board.

Core Curriculum: The term "core curriculum" is not an official term used in any of the ACGME's requirements. The term, however, has developed among practitioners when referring to those elements of a resident's curriculum common across all specialties. These common elements are now incorporated into the general competencies. The competencies themselves do not constitute a curriculum. Rather, they are the organizing principles upon which a core curriculum can be developed.

Curriculum: A curriculum is a formal educational plan based on results of a needs assessment, and including goals and objectives developed to meet the needs identified, educational activities through which the plan is implemented, and evaluation of the plan with feedback to provide continued improvement in the educational process.

Dreyfus Model: The research of Hubert and Stuart Dreyfus demonstrated what has become a widely-accepted model of how individuals progress through various levels in their acquisition of skill. The Dreyfus brothers labeled individuals in these progressive stages as novice, advanced beginner, competent, proficient, and expert. These stages should be reflected in curriculum planning when considering at which appropriate levels residents should be introduced to particular skills.

Educational Taxonomy: Taxonomies were developed in recognition that learning occurs in various domains, i.e., cognitive, affective, and psychomotor. Most often, taxonomies are used with regard to cognitive learning. While Benjamin Bloom and his colleagues developed the most recognized taxonomy, other individuals such as Marzano have proposed other taxonomies that organize cognitive knowledge in different ways. Taxonomies are useful in the development of educational objectives since they typically use particular verbs to specify desired learner behaviors that can be assessed at each level of knowledge acquisition.

Formative Evaluation: In formative evaluation, findings are accumulated from a variety of relevant assessments designed for use either in program or resident evaluation. In resident evaluation, the formative evaluation is intended to provide constructive feedback to individual residents during their training. In program evaluation, formative evaluation is intended to improve program quality. In either situation, formative evaluation is not intended to make a go/no-go decision.

General Comptencies: The six general competencies endorsed by the ACGME at its September 1999 meeting are patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice. Language related to the general competencies has been added by the Residency Review Committees to each set of core Program Requirements and by the Institutional Review Committee to the Institutional Requirements. The competencies act as organizing principles for the curricula of all core specialty programs and reflect the expectation that graduating residents should exhibit behaviors reflective of these competencies at a level appropriate to an independent practitioner. The American Board of Medical Specialties (ABMs) has also endorsed the general competencies for use by certifying boards in the examination and recertification of physicians.

Generalizability: Measurements (scores) derived from an assessment tool are considered generalizable if they can be shown to apply to more than the sample of cases or test questions used in a specific assessment.

Goal (educational): An educational goal states the broad target of an educational effort. Goals are typically not measurable, but offer a general focus for an activity or set of experiences.

Graduate Medical Education Core Curriculum(AAMC): This report from an AAMC working group presents five domains of learning that comprise the core curriculum: biomedical ethics, scholarly medical practice, communication in medicine, medical professionalism, and the healthcare system. For each domain, the report presents examples of measurable learning objectives. The terminology used to identify the domains differs from the general competencies. However, a table identifying parallel relationships between the competencies and the domains provides easy reference for how the objectives can be incorporated into GME competency-based curricula.

Objective Educational: An educational objective is a measurable target to be achieved by an educational activity or intervention. The educational objective specifies the educational outcome to be assessed.

Outcomes Assessment (educational): Outcomes are results providing evidence that goals and objectives have been accomplished. In the context of the ACGME Outcome Project, educational outcomes assessment refers to intermediate or end results of the educational process. General categories of outcomes relevant to determining educational program effectiveness include: student/resident outcomes (e.g., learning or development of knowledge, skills, and attitudes); graduate/alumni outcomes; faculty outcomes (e.g., improved teaching, increased knowledge, etc.); patients and society in general (e.g., better treatment, access to care, improved health); departmental outcomes (e.g., improved facilities, clinical benchmarks, etc.); and institutional outcomes (e.g., improved quality rating, staff satisfaction, etc.) Outcomes can occur (and be measured) at any time or point in a process, such as during a patient encounter, during a conference, throughout a rotation, throughout the educational program, etc. Outcomes can be immediate, short term, delayed, and long term.

Reliability/Reproducibility/Dependability: A reliable test score means that when measurements (scores) are repeated, the new test results are consistent with the first scores for the same assessment tool on the same or similar individuals. Reliability is measured as a correlation with 1.0 being perfect reliability and below 0.50 as unreliable. Evaluation measurement reliabilities above 0.65 and preferably near or above 0.85 are recommended. The terms reproducibility and dependability are often used interchangeably with reliability.

Summative Evaluation: In summative evaluation, findings and recommendations are designed to accumulate all relevant assessments for a go/no-go decision. In resident evaluation, the summative evaluation is used to decide whether the resident qualifies to continue to the next training year, should be dropped from the program, or at the completion of the residency, should be recommended for board certification. In program evaluation, summative evaluation is used to judge whether the program meets the accepted standards for the purpose of continuing, restructuring, or discontinuing the program.

validity: Validating assessment measures is a process of accumulating evidence about how well the assessment measures represent or predict a resident's ability or performance. Validity refers to the specific measurements made with assessment tools in a specific situation with a specific group of individuals. It is the scores, not the type of assessment tool that are valid. For example, it is possible to determine if the written exam scores for a group of residents are valid in measuring the residents' knowledge, but it is incorrect to say that "all written exams" are valid to measure knowledge.