ACGME Outcomes Project: Developments at SEA

cademic anesthesiology programs involved in residency training have been tasked by the Accreditation Council for Graduate Medical Education (ACGME) to incorporate the six ACGME competencies into the training and evaluation of their residents. These competencies are: patient care, medical knowledge, practice-based learning and improvement, professionalism, communication and interpersonal skills, and systems-based practice.^{1, 2}

The ACGME Outcomes Project was developed to ascertain improvement in educational outcomes for both the trainee as well as the training program. Recognizing that this process will take considerable education, adaptive thinking and capitalizing on the ingenuity of the many medical educators who populate our residency programs, the ACGME leadership instituted a timeline (Phase 1-4) for implementation of this project.

Phase 1 (July 2001-June 2002):
Forming an initial RESPONSE to changes in Requirements.

Phase 2 (July 2002-June 2006):
Sharpening the FOCUS and definition of the competencies and assessment tools.

Phase 3 (July 2006-June 2011):
Full INTEGRATION of the competencies and their assessment with learning and clinical care.

Phase 4 (July 2011 and beyond):
EXPANSION of the competencies and their assessment to develop models of excellence.¹

Thus residency programs need to:

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

• Use increasingly more dependable methods of assessing residents’ attainment of these competency-based objectives.

• Use outcome data to facilitate continuous improvement of both resident and residency program performance.³

The Society for Education in Anesthesia (SEA), which celebrates its 20th anniversary this year, was established to “Teach Teachers to Teach” as well as to provide an educational forum for program directors, clerkship directors and anesthesiology educators. An Internet survey of our members (April 2002) to establish goals for the next two years confirmed that many members felt that SEA should take a leadership role in ACGME competency development. More specifically our membership felt that SEA, as a Society, should establish curricular and evaluative tools for these competencies, making them easier to apply to our specialty, and in so doing, create a resource for program directors around the country as they meet the challenges and requirements set by the ACGME Outcomes Project.

Thus the SEA Task Force on ACGME Competency was created and was charged as follows to:

• Identify leadership for each of the six competencies

• Define competency as it relates to anesthesiology

• Define tools for evaluating these competencies

• Establish a database of resources for program directors.

The task force was established at the SEA Annual Spring Meeting held in June 2003 and was comprised initially of 13 individuals, two for each competency and one educationalist consultant. The task force was co-led by Stephen J. Kimatian, M.D., and John E. Tetzlaff, M.D., and competency development took place through e-mail correspondence with time set aside at the next Annual Fall Meeting to reconvene. Sample questions asked of the task force included: “What actions or attributes of a consultant anesthesiologist model competency as described by the ACGME?” “How are these actions or attributes modeled and taught to our residents?” and “How are these actions and attributes best evaluated in a resident?”

The six competency working groups were asked to address these questions for their particular competency, review the relevant literature and develop new ideas and applications. A decision was made to use the 2004 Annual Spring Meeting as a forum to share the work of the task force with the membership, further explore and develop the concepts and focus future work of the task force. The workgroup leaders were asked to become workshop coordinators for each of the six competencies at this meeting, thus bringing together anesthesiology educators from around the United States to develop a “consensus” approach to defining and establishing evaluative instruments that might be used in competency evaluation. In an effort to actively engage ACGME early in our work, Judith S. Armbruster, Ph.D., Executive Director for the Residency Review Committee for Anesthesiology, and Patricia M. Surdyk, Ph.D., Senior Project Manager in the ACGME research department, were invited as speakers and asked to be active participants in several of the workshops.

The Annual Spring Meeting attracted 120 anesthesiology educators representing at least 20 U.S. anesthesiology programs. All six competencies were addressed in workshop format, definitions of the competencies agreed upon and useful assessment tools were determined. Consistent with the charge to the task force, this work is now available on the SEA Web site at <www.seahq.org/Core/index.htm>, which also provides detail of the anesthesiology educators involved in the process, with e-mail addresses for consultation purposes. This site is a work in progress that will continue to evolve as the task force continues to explore how competency is defined and evaluated in anesthesiology.

By invitation of Dr. Armbruster, the work of the SEA Task Force on ACGME Competency was recently presented to the RRC for Anesthesiology by Dr. Kimatian and myself. The RRC was very supportive of this effort and agreed to endorse this as a resource for anesthesiology programs as they address the ACGME Outcomes Project.

As the outgoing president of SEA, I am indebted to the many members of our Society who worked together to establish this comprehensive body of work.

References:

1. Working Guidelines. ACGME Outcomes Project. <www.acgme.org/outcome/project/timeline/TIMELINE_index_frame.htm>. Accessed on November 5, 2004.

2. Mets B. ACGME Outcomes Project: A challenge to enhance patient care. ASA Newsl. 2003; 67:(9):38-39.

3. ACGME Outcomes Project: Enhancing residency education through outcomes assessment. <www.acgme.org/outcome/ project/OutIntro_fnl1.htm>. Accessed on November 5, 2004.

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

Stephen J. Kimatian, M.D., is Assistant Professor of Anesthesiology and Pediatrics and Associate Residency Director for Anesthesiology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania.