The Association of American Medical Colleges (AAMC), the American Association of Colleges of Osteopathic Medicine (AACOM), and the Accreditation Council for Graduate Medical Education (ACGME) are co-sponsoring an initiative to create a common set of foundational competencies for use in undergraduate medical education programs in the United States.
This initiative aligns with recommendations outlined in the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) report and is part of a comprehensive effort by all three organizations to improve the transition to residency.
The co-sponsoring organizations are committed to capturing and incorporating diverse voices from across the medical education community and have collected input from nearly 1,000 medical educators, physicians, medical students, residents, patients and caregivers.
The AAMC, AACOM, and ACGME are co-sponsoring this collaborative effort and partnering with other organizations across the medical education continuum to develop a set of foundational competencies for undergraduate medical education (UME).
Through this initiative, a set of foundational competencies will be developed for use in UME programs in the United States. “Foundational” refers to the early education and training of all students regardless of their future specialty or subspecialty and excludes specialty-specific competencies.
In recognition of the need to improve the undergraduate medical education (UME) to graduate medical education (GME) transition, the Coalition for Physician Accountability endorsed a core competency framework for all physicians and in 2014 proposed a unifying framework across training that contains six general but essential domains of competence. To maintain consistency across the continuum of training from UME to GME, the three sponsoring organizations (all members of the Coalition for Physician Accountability) have committed to utilizing the six core competency framework.
“An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes.” Source: Frank, JR., Snell, L., ten Cate, O., Holmboe, ES., Carraccio, C., Swing, SR., et al. (2010). Competency-based medical education: theory to practice. Medical Teacher; 32(8):638-645.
Medicine is a diverse field and training differentiates at various steps across the continuum. The purpose of the foundational competencies will be to describe the behavioral outcomes expected for all graduates of U.S. medical schools before they enter specialty-based GME. Importantly, these competencies may not address the entirety of what is necessary for a graduate who pursues training in a particular specialty. Therefore, the foundational competencies will be designed to represent the outcomes of all graduates inclusive of both DO and MD degree-granting schools, regardless of their post-medical school graduation trajectories or specialty choices.
The Liaison Committee on Medical Education (LCME®) is recognized by the U.S. Department of Education to serve as the accreditation body for US medical school programs awarding the MD degree. The AAMC and the American Medical Association co-sponsor the LCME accrediting authority; neither sponsor has a role in setting accreditation standards or requirements, making accreditation decisions, or designing and implementing accreditation processes. Although the LCME accepts and considers input from others, it makes decisions about accreditation standards independently. Thus, the LCME will be informed of, but not directly involved in, this work, and adoption of the resulting competencies will not be a specific requirement for accreditation.
The Commission on Osteopathic College Accreditation (COCA) of the American Osteopathic Association (AOA) is recognized by the U.S. Department of Education as the accreditor of colleges of osteopathic medicine. COCA accreditation signifies that a college has met or exceeded the commission's standards for educational quality. COCA will be informed of the work of revising the competencies.
During an earlier phase of this project, we explored how educators conceive of and operationalize competency-based education (CBE) for UME. We recognize that substantial work has been dedicated to CBE research, development, implementation, and assessment in both the MD and DO communities. We are not starting from scratch and are building upon and being informed by this literature and these lessons. Even before we started this project, we recognized that the PCRS and the Core EPAs are in need of updating. Instead of revising those CBE resources, we chose to first define what is foundational to UME. A solid base of foundational competencies will allow for a future set of Core EPAs or learning objectives for UME.
The foundational competencies will be organized by the six core competency framework widely endorsed in 2014 by the Coalition for Physician Accountability. Competency is defined as an “observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes.” Since competencies are observable, they can be measured and assessed to ensure their acquisition. These assessments may take multiple forms and methods of assessment may not be currently available. The existence or lack of available assessment methods should NOT limit the development of competencies. In other words, competencies should drive assessment and not vice versa. An Entrustable Professional Activity (EPA) is defined as an “essential task of a discipline that a learner can be trusted to perform with limited supervision in a given context and regulatory requirements, once sufficient competence has been demonstrated.” As a result of this project, existing EPAs will be refined and/or new EPAs will be developed once the competencies are complete.
The foundational competencies are being defined to create a common framework for competency-based education in UME. Use cases include curriculum and programmatic assessment design. Ultimately, the ways in which medical schools utilize these foundational competencies will be determined by the schools themselves. This project is not designed to be a mandate, but rather to provide an important tool for furthering competency-based medical education.
The foundational competencies will represent expected outcomes in six broad areas that were widely endorsed across the field in 2014 (Professionalism, Patient Care and Procedural Skills, Medical Knowledge, Practice Based Learning and Improvement, Interpersonal and Communication Skills, and Systems Based Practice). These will be intended to represent minimum competencies for all medical students, regardless of degree type or eventual specialty of practice. Other competencies, such as those in the “New and Emerging Competencies Series” are intended to add depth to key emerging thematic areas and guide curricular and professional development, especially in areas that are under-represented in the educational program. Both thematic and foundational competencies are intended to guide formative performance assessment, cross-continuum collaborations, and, ultimately, improvements in health care services and outcomes.
Dr. Edgar is the ACGME’s Vice President for Milestone Development. She leads volunteers and staff members through the development of Milestones and related materials for all ACGME-accredited specialties. Dr. Edgar creates and manages the Milestones resources that aid program directors, learners, and Clinical Competency Committees. She serves as a liaison to the medical education community and is a frequent speaker on topics related to the Milestones, Clinical Competency Committees, assessment, education, and accreditation.
Dr. Holmboe is Chief, Research, Milestones Development and Evaluation Officer at ACGME. He is also Adjunct Professor at Yale University, the Uniformed Services University of the Health Sciences, and the Northwestern University Feinberg School of Medicine. His research interests include interventions to improve quality of care and methods in the evaluation of clinical competence.
Dr. Howley is Senior Director for Transforming Medical Education at the Association of American Medical Colleges. She is an educational psychologist specializing in medical and health professions education and joined the AAMC in 2016 to advance the continuum of medical education, support experiential learning, competency based education, and lead curricular transformation across its member institutions and their clinical partners. She is also an adjunct associate professor at the University of North Carolina Chapel at Hill School of Medicine.
Dr. Kirk is the Chief Accreditation and Recognition Officer at the ACGME and Professor Emeritus of Internal Medicine at University of Texas (UT) Southwestern Medical Center in Dallas. She has served successively as Associate Dean for Medical Education, Director in the Office of Medical Education, Associate Dean of Undergraduate Medical Education, and Clinical Sciences Director at UT Southwestern.
Dr. Speicher, as senior vice president of learning, research and innovation, is responsible for overall organizational improvement, including leadership development, Competency-Based Medical Education, and osteopathic medical education systems development. He also leads AACOM’s efforts to identify and develop new projects that advance osteopathic medical education, generate new revenue and/or address related challenges.
Professor and Senior Associate Dean, Office of Innovation in Health Professions Education
Associate Dean for Medical Education; Professor of Medicine, Division of Hospital Medicine
Associate Vice Chair for Justice, Equity, Diversity, and Inclusion
Clerkship Director and Associate Program Director
Assistant Dean of Medical Education for Curriculum and Instructional Design
Instructor of Medical Education
Assistant Professor of Medical Education, Director of Clinical Clerkships, Medical Director of Simulation, Associate Program Director - General Surgery Residency
Clerkship Director; Associate Professor
Academic Hospitalist; School of Medicine Acting Internship Director; Associate Professor, Department of Internal Medicine
Associate Dean, Competency Assessment and Professional Standards; Professor of Medicine
Clerkship Director; Associate Professor of Family Medicine
Professor of Physiology and Pharmacology, Division of Anatomy and Molecular Medicine
Associate Dean for Assessment and Educational Development
Assistant Dean of Assessment, Evaluation and QI; Interim Assistant Dean of Curriculum; Clinical Professor of Internal Medicine and Learning Health Sciences
Faculty Director of Simulation; Assistant Professor, Department of Clinical Science
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MetroHealth, Department of Internal Medicine; Assistant Dean for Longitudinal Clinical Education; Associate Professor, Center for Medical Education
Interim Dean of Academic Affairs; Professor
Senior Associate Dean, Medical Education; Associate Professor, OB/GYN
Senior Vice Dean, Vice Dean of Medical Education, and Professor of Ophthalmology at the Wayne State University School of Medicine
Senior Vice President, Certifying Board Services
General surgery resident at Northwell Health
Dean; Senior Vice President for Health Affairs; and Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University
Clinical Assistant Professor of Obstetrics and Gynecology and Clerkship Director for obstetrics and gynecology at Texas A&M School of Medicine
Associate Professor of Pediatrics in the Division of Pediatric Critical Care Medicine at Vanderbilt University School of Medicine
Faculty, Mercer School of Medicine; President of the International Association of Medical Science Educators
Assistant Dean for Clerkship Education, Michigan State University College of Osteopathic Medicine
Associate Vice President for Competency-Based Assessment at National Board of Medical Examiners
Senior Education Specialist
Curriculum Assessment Program Evaluation (CAPE)
Mayo Clinic Alix School of Medicine
Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Residency Program Director of Obstetrics and Gynecology, North Shore University Hospital
Professor of Integrative Physiology and co-director of the Graduate Program in Integrative Medicine & Health Sciences at Georgetown University Medical Center
Vice President of Undergraduate Medical Education Innovations at the American Medical Association
Professor of clinical medicine and Senior Associate Dean for GME and Faculty Affairs at the Miller School of Medicine, University of Miami
Associate Dean of Clinical Competencies and an Associate Professor of Pediatrics at SUNY Downstate Health Sciences University College of Medicine
Chief Executive Officer of Intealth
President of the Educational Commission for Foreign Medical Graduates (ECFMG)
Board Chair of the Foundation for Advancement of International Medical Education and Research (FAIMER), ECFMG’s nonprofit foundation
Professor Emerita of Medical Education and Psychiatry at Wright State University Boonshoft School of Medicine
Pediatrician and Associate Professor of Pediatrics at the University of Colorado Anschutz Medical Center
Vice President for Professional Development Initiatives and Communications, National Board of Osteopathic Medical Examiners
Third-year osteopathic medical student at Philadelphia College of Osteopathic Medicine –South Georgia campus
Vice Chair for Education and Academic Affairs, and Director of Residency Training at The University of Chicago
Chief Internal Medicine resident and Captain in the U.S. Army at the Western Michigan University Homer Stryker M.D. SOM
Dean of New York Institute of Technology College of Osteopathic Medicine
Professor of Medicine in the Division of Gastroenterology at NYU Grossman School of Medicine
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