What is “Competency” in the New Millennium? Shirley Schlessinger, MD, FACP Associate Dean for Graduate Medical Education University of Mississippi Medical Center

“Competency”  Main Entry: com·pe·tent 1 : proper or rightly pertinent 2 : having requisite or adequate ability or qualities : FIT 3 : legally qualified or adequate FIT 4 : having the capacity to function or develop in a particular way; specifically : having the capacity to respond (as by producing an antibody) to an antigenic determinant  synonym see SUFFICIENT SUFFICIENT

Competency In GME  Historically like pornography? (“know it when you see it…”)  Ad hoc local standards, assessment tools  Traditionally defined around “Knowledge, Skills, Attitudes”  National focus on “accountability,” patient safety, quality of medical care  2001 ACGME and ABMS defined 6 domains of “competency”  ALL physicians completing graduate medical training must be competent in all 6 areas

Domains of Competency  Medical Knowledge  Patient Care  Professionalism  Communication Skills  Practice Based Learning & Improvement  Systems Based Practice

Medical Knowledge  Must demonstrate knowledge of established and evolving biomedical, clinical, and social sciences  Application of medical knowledge to patient care: clinical problem- solving, clinical decision-making, and critical thinking  Apply an open-minded, analytical approach to acquiring new knowledge

Patient Care  Provide compassionate, appropriate and effective patient care  Promote health, prevention of illness, treatment of disease, and end of life care  Gather accurate essential information from all sources  Develop and implement effective patient management plans  Perform competently diagnostic and therapeutic procedures (essential to IM)

Professionalism  Reflect commitment to continuous professional development, ethical practice, and understanding and sensitivity to diversity  Responsible attitude toward patients, profession, and society  Demonstrate respect, compassion, integrity, and altruism  Adhere to principles of confidentiality, scientific integrity, and informed consent  Recognize and identify deficiencies in peer performance

Interpersonal & Communication Skills  Establish and maintain professional relationships with patients, families, and other health care team members  Use effective listening, nonverbal, questioning, and narrative skills to communicate with patient and families  Interact with consultants in a respectful, appropriate manner  Maintain comprehensive, timely, and legible medical records

Practice Based Learning & Improvement  Use scientific evidence and methods to investigate, evaluate, and improve patient care practices  Implement strategies to enhance knowledge, skills, attitudes and processes of care  Analyze clinical practice to improved quality of patient care  Be willing to learn from errors  Use technology to manage information

Systems Based Practice  Understand the contexts and systems in which health care is provided  Effectively utilize resources to provide optimal care  Apply evidence-based, cost-conscious strategies to prevent, diagnose, and manage disease  Collaborate with other health care team members to improve processes of care

The Competency Framework  Use the 6 domains of competency to “frame” both formative and summative feedback  ABIM standard evaluation requires scoring the resident in each area  Ask residents to perform “self- assessments” in the competency domains

Focus on PBLI & SBP  Conceptually “newest” competencies  Often hardest for attending faculty to develop comfort in evaluating  Questions can help guide the assessment of your resident…

PBLI  Does the resident voluntarily discuss and research relevant literature to support decision-making processes?  Does the resident effectively and efficiently use consulting services to improve both patient care and self-knowledge?  Does the resident teach junior colleagues and peers appropriately?  Does the resident use information about self-errors to change behavior/improve care?  Does the resident participate actively in QI practices (M&M) and review autopsies?

SBP  Does the resident identify the patient’s resources, and provide optimal care within those boundaries?  Does D/C planning begin at admission?  Does the resident arrange appropriate patient care follow-up?  Does the resident use hospital and out- patient resources effectively?  Does the resident use practice guidelines appropriately?

And the true challenge… Strive not for “competence” but for excellence! And the true challenge… Strive not for “competence” but for excellence!