Competency and the Six Core Competencies

95 " The Congress has found the following: (1) The Federal government, through its Medicare program, pays approximately $8 billion per year solely to train resident-physicians in the United States, and as a result, has an interest in assuring the safety of patients treated by resident-physicians and the safety of resident-physicians themselves. " 1 With this prologue to House bill HR 3236, lawmakers expressed their growing interest in graduate medical education. Their concerns are not only with patient safety but also with the competency of the physicians being trained. Naturally, it followed that this interest would prompt an inquiry into the training and competency of resident-physicians. Over the past several years, medical educators have found that they must not only prepare well-qualified physicians but that these trained physicians must also be prepared in the most cost-effective manner. A new paradigm and new standards were required to train the latest generation of physicians. The teachers of medicine, who traditionally held themselves above politics , were thrust into the fray. It also follows that the same standards for which resident-physicians are held will, in good time, be applied to all practicing physicians. But what standards and whose definition of competency should be adopted to characterize a practicing physician. Only minimal progress has been made in defining these standards for independent practitioners. But the issues of competency and core compe-tencies have been studied in residency programs and have generated a great deal of intellectual ferment. It is, therefore, instructive to study the evolving form that com-petency parameters are taking in graduate medical education , for these same parameters eventually will be applied to private practitioners. Residency programs today are judged by a " minimum threshold " according to how they comply with standards set by the Accreditation Council for Graduate Medical Education (ACGME) and their individual Residency Review Committees (RRCs). Residencies are evaluated to determine whether they comply with the " Requirements " of the RRC. The effectiveness of a residency program to train surgeons is evaluated with tools that rely on structure and process. For example, programs are checked to see whether they have established objectives, an organized curriculum, proper teaching faculty, and a process that evaluates the program and residents, i.e., " Structure and Process. " Evaluation of structure and process, however, does not give a direct measure of the educational quality of that program. Rather, it is only a measure …