In the 2021 ACGME Annual Educational Conference session, “Moving Urgently Toward Competency-Based Assessment in GME,” presenters Richard Hawkins, MD, president and CEO of the American Board of Medical Specialties (ABMS) and Eric Holmboe, MD, MACP, FRCP, chief research, Milestone development, and evaluation officer at the ACGME, stated that “the ultimate outcome for graduate medical education is the Quadruple Aim: better outcomes; improved clinician experience; lower costs; improved patient experience.”
Dr. Hawkins began the session with a review of the mission of the ABMS, and went on to explain that ABMS initial certification isn’t just about the high-stakes exam. It also includes meeting initial requirements for licensure, successful completion of an ACGME-accredited program, and then passing the assessments. In some cases, there are additional, discipline-specific requirements. The structure of education combined with assessment is critically important, in addition to the exam itself. A further requirement, a statement by the program director that the physician can “practice independently and without supervision,” is a key element in certification. Initial certification is not just an exam—it is a process.
Dr. Holmboe pointed out that the ability of both the ABMS and ACGME to deliver on their organizations’ respective missions has been threatened by disruption in education and training, assessment, and practice as a result of the COVID-19 pandemic. “We are acutely aware of the sacrifices and professionalism that have been exhibited on the front lines during the pandemic,” he said.
Most programs experienced significant disruption due to the pandemic, including health impacts among faculty members, residents, and fellows and disruptions in educational activities and clinical care. The ABMS and ACGME worked together from early on in the pandemic to ensure there was alignment between accreditation and certification, developing limited exemptions to standards and modifications to requirements, and issuing a statement of joint principles in April 2020.
The ABMS and ACGME expect programs to use rigorous, valid, and reliable combinations of assessments that are appropriate within each specialty. A joint ABMS/ACGME task force worked to provide guidance regarding implementation of competency-based assessment.
In fact, both organizations endorse and rely on the authority and judgement of Clinical Competency Committees (CCCs) and program directors to determine residents’ and fellows’ readiness for unsupervised practice, and expect them to use assessment methods appropriate for each specialty, including competency-based medical education, an approach to preparing physicians that is oriented to abilities organized around competencies, de-emphasizing time-based training. Competency-based assessment promises greater accountability, flexibility, and learner-centeredness.
The presenters reviewed each of the six Core Competencies: professionalism; patient care and procedural skills; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; and systems-based practice. They also described competency-based assessment options for each Competency.
Dr. Holmboe recommended a careful review of the growing body of literature on CCCs, including updated resources on the ACGME website, including:
Dr. Holmboe mentioned that the ACGME offers faculty development courses on assessment, currently in an online format, and went on to describe two additional ACGME resources that can help with assessment and feedback in GME programs. One, the Direct Observation of Clinical Care (DOCC) app, is a smart phone app that allows faculty members and other evaluators to implement on-the-spot or scheduled direct observation assessments of residents and fellows performing five clinical activities in which they are expected to achieve competence.
The other resource, the Teamwork Effectiveness Assessment Module (TEAM), is a web-based assessment tool for programs that enables the collection of multi-source feedback on residents' and fellows' professionalism, interpersonal and communication skills, interprofessional teamwork, and aspects of systems-based practice.
Dr. Hawkins closed the session by pointing out that the disruption caused by COVID-19 has created an opportunity to move rapidly to competency-based assessment in GME.
“The ABMS and the ACGME trust the GME community to make competency-based decisions grounded in close observation, robust assessment, and a shared interest in supporting the GME community in delivering a competent workforce in the best interests of the public,” he concluded.