ACGME Outcomes Project: A Challenge to Enhance Patient Care

We are currently in the second phase of the Accreditation Council for Graduate Medical Education (ACGME) Outcomes Project.

Acknowledgement of this endeavor is not only important to ASA members who are directly involved in resident education but also to practicing nonacademic anesthesiologists. This is because it is conceivable that tools used to assess anesthesiology resident competence may well form the basis for Maintenance of Certification (MOC) by the American Board of Anesthesiology in the future. (MOC has as one of its components the need to demonstrate practice performance.¹)

ACGME, in concert with the Institute of Medicine, the Joint Commission on Accreditation of Healthcare Organizations, the American Board of Medical Specialties and the Association of American Medical Colleges, is increasingly concerned about patient safety and assuring the public that practitioners are competent to practice their specialties.

Recognizing this accountability, ACGME, under the leadership of David Leach, M.D., refined and developed the Outcomes Project.

The essence of this project is an increasing emphasis on ascertaining improvement in educational outcomes (and so by extension, improvement in the health of patients and society in general) for both the trainee as well as the training program. This will be effected through the mechanism of program recertification.

Competency
ACGME recognized that residency programs were being evaluated and certified for their potential for training residents, rather than the result of this training, by stipulating the number of cases a resident needed to do or the number of procedures performed. After input from the many stakeholders in medical education as well as a review of the existing research on general competencies for physicians, the Outcomes Project Advisory Committee defined six general competencies that were approved by ACGME in September 1999. These are:

• Patient Care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health;

• 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;

• Practice-Based Learning and Improvement that involves self-investigation and self-evaluation of patient care, appraisal and assimilation of scientific evidence and improvements in patient care;

• Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families and other health professionals;

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

• 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 call on system resources effectively to provide care that is of optimal value.

In order to drive the process for residency training programs to adopt these concepts, ACGME has incorporated these concepts in the program and institutional requirements. Thus residency programs need to:

• Identify learning objectives related to ACGME’s general competencies.

• Use increasingly more dependable (i.e., objective) methods of assessing residents’ attainment of these competency-based objectives.

• Use outcome data to facilitate continuous improvement of both resident and residency program performance.²

Recognizing that this process will take considerable education, adaptive thinking and capitalization on the ingenuity of the many medical educators that populate our residency programs, the ACGME leadership has instituted a timeline (Phase 1 through 4) for implementation of this project through 2011 and beyond. These phases are:

• Phase 1 (7/01-6/02) Forming an initial RESPONSE to changes in requirements.

• Phase 2 (7/02-6/06) Sharpening the FOCUS and definition of the competencies and assessment tools.

• Phase 3 (7/06-6/11) Full INTEGRATION of the competencies and their assessment with learning and clinical care.

• Phase 4 (7/11 and beyond) EXPANSION of the competencies and their assessment to develop models of excellence.³

For each of these phases, there are requirements for programs and Residency Review Committees (RRCs) that can be accessed at <www.acgme.org/Outcome/project/Timeline.pdf>.

We are currently in Phase 2. In the event that a residency program is about to be reviewed for reaccreditation, program directors will need to complete a specific addendum to the Program Information Form. This addendum tracks the assessment methods that have been employed to address the general competencies as well as one or two “improvements” that have been incorporated into the program to enhance competency instruction or assessment.

ACGME has provided a “toolbox” of assessment methods, which can be accessed readily at its Web site, that may form the basis for some of the required assessments. However, it is hoped that programs will use their collective ingenuity to develop novel tools to perform these assessments. To this end, a “clearinghouse” for novel techniques and program developments has been created on this Web site under the acronym RSVP (Recognize Success Via imPlementation) <www.acgme.org/outcome/implement/rsvp.asp>.

In summary, the ACGME Outcomes Project is a long-term initiative by which ACGME is increasing emphasis on educational outcomes in the accreditation of residency education programs.

In its spring and fall national meetings as well as its ASA Breakfast Panels, the Society for Education in Anesthesia has focused increasingly on enhancing the awareness and knowledge of the importance and implications of the ACGME Outcomes Project.

Berend Mets, M.B., Ch.B., Ph.D., is Eric A. Walker Professor and Chair, Pennsylvania State College of Medicine/Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania.