ACGME Competencies & Milestones
Competencies
In 1999, the Accreditation Council for Graduate Medical Education (ACGME) adopted a set of key competencies, essential for every practicing physician. Known as the ACGME Core Competencies, these six skill sets were designed to mold and assess the training of resident physicians. ACGME’s goal was to establish educational programs that embody skills and characteristics vital to patient care, equipping residents for effective practice. Subsequently, the American Board of Medical Specialties (ABMS) has incorporated these ACGME core competencies into its Maintenance of Certification (MOC) program.
The ACGME Core Competencies encompass a comprehensive set of skills essential for physicians, emphasizing not only the delivery of superior patient care in diagnosis and treatment but also the broader aspects of medical practice. These competencies include the ability to lead and work effectively within healthcare teams, demonstrating strong leadership skills that are crucial in today’s complex healthcare environment. Additionally, they highlight the importance of teaching ability, recognizing that physicians often play a pivotal role in educating not only patients and their families but also other healthcare professionals and trainees.
Quality improvement is another critical aspect of these competencies, requiring physicians to engage in continuous efforts to enhance patient health and wellness. This involves implementing innovative strategies to improve patient outcomes and ensuring high standards of care. Furthermore, the competencies extend to interpersonal relationships with other healthcare providers, fostering collaboration and effective communication within the multidisciplinary healthcare team.
Moreover, the competencies stress the significance of offering comprehensive care that goes beyond physical treatment. This includes providing emotional support to patients, understanding and addressing their psychological needs, and effectively interacting with patients’ families and support systems. Through these varied aspects, the ACGME Core Competencies aim to create well-rounded physicians who excel in multiple facets of healthcare, ensuring the highest level of patient care and wellbeing.
The six core competencies are as follows (it is worth mentioning that these categories are the same for all medical specialties)
- Medical Knowledge (MK)
- Patient Care and Procedural Skills (PC)
- Systems-Based Practice (SBP)
- Practice-Based Learning and Improvement (PBLI)
- Interpersonal and Communication Skills (ICS)
- Professionalism (PROF)
Medical Knowledge: Understanding the important anatomy, physiology, pharmacology and pathology needed for the practice of medicine.
Patient Care: Development of H&P skills, DDx skills, and management skills. This includes procedural skill and treating emergencies.
System Based Practice: Optimizing the interconnection between the human and non-human elements of the work environment.
Practice Based Learning & Improvement:
Application of EBM, as well as lifelong learning skills.
Interpersonal and Communication skills:
Communication with patients, family, collogues and in medical documentation.
Professionalism:
Ethics, duties, and well-being.
Milestones
Along with development of the competencies, the ACGME, in collaboration with the ABMS member boards, has developed unique milestones for each medical specialty, aligning with the six fundamental competencies. These milestones serve as a structure for evaluating both residents and practicing physicians. They outline critical aspects of each competency that physicians are expected to exhibit. By identifying the specific knowledge, skills, and attitudes associated with each ACGME Core Competency and its subcategories, the ACGME is able to measure the preparedness of residents as well as the effectiveness of medical training programs. This approach ensures a comprehensive and quantifiable assessment of medical education and professional development.
It is important to point out that Milestones are specialty-specific. Although some milestones may apply to several specialties, most specialties define their own set of milestones to assess competency within that area of medicine.
The milestone evaluation system ranges from “not yet assessable” to “aspirational,” providing a progressive scale for assessing resident competence. Initially, residents are expected to start at the lower end of this scale, gradually advancing as they gain more knowledge and experience.
At the beginning of the scale, residents may show “critical deficiencies,” indicating a substantial lack of performance that falls outside the range of developing competence. As residents progress, they typically demonstrate characteristics of an early learner, followed by those of an advanced learner, showing marked improvements in their abilities.
A resident reaches the “ready for unsupervised practice” stage when they exhibit skills comparable to those of an established practicing physician, capable of working independently without constant oversight. This level of proficiency is the ultimate objective of any medical training program. However, some residents might achieve this level of competency in various milestones during their training.
The highest point on this scale is the “aspirational” stage, where a resident not only meets but surpasses the milestones, emerging as an expert or a model professional. The “aspirational” level is typically reserved for those residents who exhibit exceptional performance and mastery in their field.
