The New Competencies - 2003
Wendy Levinson, MD
University of Toronto Faculty of Medicine (Scientific American Medicine-
WebMD)
What are the skills and competencies required to be a superb internist in the
present health care environment? What will the public want and demand from
our profession? These questions are addressed by the Accreditation Council
for Graduate Medical Education (ACGME) and the American Board of Medical
Specialties (ABMS) in their new rules for assessing the competency of
residents and practicing physicians. Previewing these competencies will help
to answer two additional questions that impact our livelihoods: How will our
profession set the new standards for competencies of an internist and how
will those standards be enforced?
The ACGME and ABMS have collaborated on six general competencies for
residents in training and physicians practicing in multiple specialties.
Starting in June of 2001, they developed the working definitions for each of
these general competencies, which will form the basis for the assessment of
training programs, residents, and practicing physicians. The general
competencies include the following areas: (1) medical knowledge, (2)
interpersonal and communication skills, (3) patient care, (4)
professionalism, (5) practice-based learning and improvement, and (6) systems-
based practice.
Obviously, several of these areas are familiar territory for practicing
internists--patient care skills and medical knowledge are fundamental to what
we do. And we train young internists to develop excellence in these areas
before they launch into professional practice. However, several of these
competencies are new additions--practice-based learning and improvement and
systems-based practice, for example.
The internal medicine organizations have articulated the specific working
definitions of skills in these new competencies that will eventually form the
basis for further professional evaluation. For example, practice-based
learning improvement requires that trainees be able to use scientific
evidence and methods to investigate, evaluate, and improve patient care
practices. This requires the following specific skills:
The ability to identify areas for improvement and to implement strategies to
enhance knowledge skills, attitudes, and care processes.
The ability to analyze and evaluate practice experiences and implement
strategies to continuously improve the quality of patient practice.
The ability to develop and maintain a willingness to learn from errors and
use errors to improve the system or processes of care.
The ability to use information technology or other available methodologies to
access and manage information, to support patient care decisions, and to
enhance both patient and physician education.
Hence, it is expected that residency programs will develop ways to teach and
to evaluate resident skills in these new areas. In parallel, the boards of
medical specialties, which are responsible for the certification and
recertification of practicing physicians, will seek new ways to assess
practicing doctors' skills in these same domains.
Clearly, this is no small feat. In order to accomplish this goal, we will
need new ways to teach medical students and residents skills in each of these
areas. We will need ways to evaluate their competencies. We will need faculty
who are comfortable teaching, assessing, and giving feedback to residents
about these skills. In fact, many of the faculty were not previously trained
in some of these areas and, therefore, will need faculty development
themselves. Practicing physicians who are not in academic settings but will
be recertifying through their board will need to broaden their concepts of
what makes an excellent internist, and they will need to seek education in
some of the competencies with which they are less familiar.
So what is the benefit of all of this? Ultimately, our goal as internists is
to provide superb care for our patients. While, in the past, much of that
care occurred one-on-one between the doctor and patient in the office or
hospital setting, it is clear that systems of care are now broader. Excellent
care depends on internists' abilities to act as a member of a team, providing
their expertise in medical knowledge and patient care (as they always have),
but now adding their skills in other areas. Ultimately, these standards will
ensure the highest quality of care and will demonstrate that we are
accountable to the public for seeking to continuously improve the quality of
care they receive.
