Graduate Medical Education

Medical school graduates seeking to receive board certification or enter independent practice must complete graduate medical education (GME, or residency training programs) of up to 8 years in length, depending on their specialty. Recognizing that the current teaching models focus more on accommodating biomedical content than on improving patient care (Leach, 2001), the Accreditation Council for Graduate Medical Education (ACGME), which accredits residency programs and sets their curricular standards, developed the Outcome Project (ACGME, 2007a)—a long-term effort to enhance the effectiveness of residency education and accreditation by increasing the emphasis on outcomes. The desired outcomes are focused on demonstrated competencies among physicians in training. Box 7-3 shows the “minimum language” version of the six general competencies endorsed by ACGME in 1999.


Internal Medicine Residency and Medical Oncology Subspecialty The American Board of Internal Medicine (ABIM) requires candidates for

BOX 7-3

General Competencies of the ACGME Outcome Project

  1. Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

  2. Medical knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care

  3. Practice-based learning and improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care

  4. Interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals

  5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

  6. Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value [emphasis added]

SOURCE: ACGME, 2007a.



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