Foundational Competencies for Undergraduate Medical Education

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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.

Engaging the Community

Project Timeline

Project timeline

Frequently Asked Questions

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.

Jonathan Amiel, MD

Columbia University

Professor and Senior Associate Dean, Office of Innovation in Health Professions Education

Todd Cassese, MD, FACP

Albert Einstein College of Medicine

Associate Dean for Medical Education; Professor of Medicine, Division of Hospital Medicine

Enrico Castillo, MD, MSHPM

University of California Los Angeles

Associate Vice Chair for Justice, Equity, Diversity, and Inclusion

Johanna Marietta Clewing, MD

Texas A&M / Houston Methodist Hospital

Clerkship Director and Associate Program Director

Molly Cohen-Osher, MD, MMedEd

Boston University Chobanian & Avedisian School of Medicine

Assistant Dean of Medical Education for Curriculum and Instructional Design

Cara Coleman, JD, MPH

Virginia Medicine

Instructor of Medical Education

Andrea Cooley, DO

University of Texas Tyler School of Medicine

Assistant Professor of Medical Education, Director of Clinical Clerkships, Medical Director of Simulation, Associate Program Director - General Surgery Residency

Nicole Cotton, MD, FAPA

Morehouse School of Medicine Psychiatry and Behavioral Sciences

Clerkship Director; Associate Professor

Adam Garber, MD, FACP, FHM

Virginia Commonwealth University Health System

Academic Hospitalist; School of Medicine Acting Internship Director; Associate Professor, Department of Internal Medicine

Karen Hauer, MD/PhD

University of California San Francisco

Associate Dean, Competency Assessment and Professional Standards; Professor of Medicine

Matthew Hawks, MD, FAAFP

Uniformed Services University

Clerkship Director; Associate Professor of Family Medicine

Mark Hernandez, PhD, FNAOME

Alabama College of Osteopathic Medicine

Professor of Physiology and Pharmacology, Division of Anatomy and Molecular Medicine

Andrew Kendle, MD

Ohio State University

Education Fellow

Machelle Linsenmeyer, EdD

West Virginia School of Osteopathic Medicine

Associate Dean for Assessment and Educational Development

Seetha Monrad, MD

University of Michigan Medical School

Assistant Dean of Assessment, Evaluation and QI; Interim Assistant Dean of Curriculum; Clinical Professor of Internal Medicine and Learning Health Sciences

Jose Parra

Touro University Nevada

Medical Student

Candace Y Pau, MD

Kaiser Permanente Bernard J. Tyson School of Medicine

Faculty Director of Simulation; Assistant Professor, Department of Clinical Science

Danielle Roussel, MD

University of Utah

Assistant Dean, Medical Student Assessment

Anastasia Rowland-Seymour, MD

Case Western Reserve University

MetroHealth, Department of Internal Medicine; Assistant Dean for Longitudinal Clinical Education; Associate Professor, Center for Medical Education

Débora H Silva, MD, MEd

University of Puerto Rico

Interim Dean of Academic Affairs; Professor

Jody Gerome Zuchowski, DO

Ohio University Heritage College of Osteopathic Medicine

Senior Associate Dean, Medical Education; Associate Professor, OB/GYN

Richard Baker, MD

Representing: Medical Education Senior Leaders

Senior Vice Dean, Vice Dean of Medical Education, and Professor of Ophthalmology at the Wayne State University School of Medicine

Maura Biszewski

Representing: Society of Osteopathic Medical Educators (SOME)

Senior Vice President, Certifying Board Services

Kevin Carroll, MD, MRCS

Representing: Educational Commission for Foreign Medical Graduate (ECFMG) - International Medical Graduates (IMG)

General surgery resident at Northwell Health

Juan Carlos Cendán, MD

Representing: AAMC Council of Deans

Dean; Senior Vice President for Health Affairs; and Professor of Surgery, Herbert Wertheim College of Medicine, Florida International University

Hector Chapa, MD, FACOG

Representing: Interprofessional Education Collaborative COMPS Revision Workgroup

Clinical Assistant Professor of Obstetrics and Gynecology and Clerkship Director for obstetrics and gynecology at Texas A&M School of Medicine

William Cutrer, MD, MEd

Representing: AAMC Group on Educational Affairs (GEA)

Associate Professor of Pediatrics in the Division of Pediatric Critical Care Medicine at Vanderbilt University School of Medicine

Bonny Dickinson, PhD, HPEd

Representing: International Association of Medical Science Educators (IAMSE)

Faculty, Mercer School of Medicine; President of the International Association of Medical Science Educators

Susan Enright, DO, FACOI

Representing: AACOM’s Group of Clinical Deans

Assistant Dean for Clerkship Education, Michigan State University College of Osteopathic Medicine

Chris Feddock, MD, MS

Representing: National Board of Medical Examiners

Associate Vice President for Competency-Based Assessment at National Board of Medical Examiners

Katherine A. Forkner, MA

Representing: Medbiquitous

Senior Education Specialist
Curriculum Assessment Program Evaluation (CAPE)
Mayo Clinic Alix School of Medicine

Nagaraj Gabbur, MD

Representing: AAMC Group on Educational Affairs (GEA) - CLASS

Assistant Professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Residency Program Director of Obstetrics and Gynecology, North Shore University Hospital

Aviad Haramati, PhD

Representing: AAMC Council of Faculty & Specialty Societies

Professor of Integrative Physiology and co-director of the Graduate Program in Integrative Medicine & Health Sciences at Georgetown University Medical Center

Kim Lomis, MD

Representing: American Medical Association, Medical Education

Vice President of Undergraduate Medical Education Innovations at the American Medical Association

Joan St. Onge, MD, MPH, FACP

Representing: AAMC Group on Resident Affairs

Professor of clinical medicine and Senior Associate Dean for GME and Faculty Affairs at the Miller School of Medicine, University of Miami

Robin (Rikki) Ovitsh, MD

Representing: Directors of Clinical Skills Courses (DOCS)

Associate Dean of Clinical Competencies and an Associate Professor of Pediatrics at SUNY Downstate Health Sciences University College of Medicine

William Pinsky, MD, FAAP, FACC

Representing: Educational Commission on Foreign Medical Graduates

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

Brenda Roman, MD

Representing: Alliance for Clinical Education

Professor Emerita of Medical Education and Psychiatry at Wright State University Boonshoft School of Medicine

Matthew Rustici, MD

Representing: TTR Course Educators Collaborative

Pediatrician and Associate Professor of Pediatrics at the University of Colorado Anschutz Medical Center

Jeanne M. Sandella, DO

Representing: National Board of Osteopathic Medical Examiners

Vice President for Professional Development Initiatives and Communications, National Board of Osteopathic Medical Examiners

Anthony Sciuva

Representing: AACOM’s Council of Osteopathic Student Government Presidents

Third-year osteopathic medical student at Philadelphia College of Osteopathic Medicine –South Georgia campus

Deborah Spitz, MD

Representing: Organization of Program Director Associations

Vice Chair for Education and Academic Affairs, and Director of Residency Training at The University of Chicago

Emmanuel Dimitri Tito, DO

Representing: AACOM’s Residents and Fellows Council

Chief Internal Medicine resident and Captain in the U.S. Army at the Western Michigan University Homer Stryker M.D. SOM

Nicole Wadsworth, DO, FACEP, FACOEP

Representing: AACOM’s Society of Osteopathic Medical Educators (SOME)

Dean of New York Institute of Technology College of Osteopathic Medicine

Renee Williams, MD, MHPE

Representing: AAMC Group on Diversity and Inclusion (GDI)

Professor of Medicine in the Division of Gastroenterology at NYU Grossman School of Medicine

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