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ACGME Launches Outcomes Assessment Project
Susan Swing, PhD
JAMA. 1998;279:1492.
The Accreditation Council for Graduate Medical Education (ACGME) recently launched a 3-year project to study ways to better incorporate educational outcomes assessment into the residency review process. The long-term goal of the project is to develop accreditation procedures that take into account not only whether residency programs provide residents with adequate opportunities to learn but also whether a program's residents actually develop into competent patient care providers and professionals. The ACGME believes that this project will lead to better ways to measure the quality of graduate medical education.
The ACGME is responsible for evaluating the quality of the 7619 residency programs in the United States and Puerto Rico. The ACGME delegates accrediting authority to 27 Residency Review Committees. The Residency Review Committees conduct the evaluations within their specialty and/or subspecialties. Traditionally, accreditation reviews have focused on process and structure variables, such as availability of facilities and equipment, number of faculty, conferences held, and rotations offered. This project will look into changing the reviews to put more emphasis on outcomes.
For outcomes assessment to be truly useful, we must first determine precisely what should be learned and measured as educational outcomes. The changes in our nation's health system have created the need to examine whether what residents are learning during residency is sufficient to provide care in an environment where some stakeholders advocate evidence-based, cost-effective, patient-centered care as a new standard. As part of its project, the ACGME will consider the emerging needs of our health system and will identify the general competencies that should be better developed during residency training to address those needs. The ACGME will also continue to ensure that residents receive specialty-specific knowledge and skills. Among the general competencies we are examining are knowledge, skills, and attitudes pertaining to medical informatics, professionalism, evidence-based decision making, medical ethics, interpersonal communication, teamwork, continuous quality improvement, and practice management in diverse health systems and settings.
Outcomes assessment will be most valuable if the results provide evidence that residents have attained essential patient care and related professional competencies and if the results offer feedback that will help improve the performance of individual residents and residency programs. Currently, the only outcome measure used by most Residency Review Committees to judge the quality of a residency program is residents' aggregate performance on certification board examinations, and the most commonly used method of assessing clinical skills during training is global ratings on categories of clinical performance, both of which fall short in one or more ways. For example, board examinations test clinical knowledge and cognitive skills but not clinical performance. Global ratings assess clinical performance but provide no specific feedback to improve performance.
The ACGME project will attempt to identify other assessment methods to supplement those currently used. Among the methods to be examined are ratings tied to specific patient encounters, ratings of patient satisfaction, objective-structured clinical examinations, graduates' perceptions of the adequacy of their education, and possibly, practice patterns.
As the ACGME proceeds with its study, we will be seeking input from different groups. We want to gather resident physicians' perceptions regarding competencies they will need in the future, the effectiveness of current educational practices for inculcating competencies, the effectiveness of assessment tools for evaluating learning and providing useful feedback, and how best to use outcomes data to improve the quality of residency education. We will gather residents' input on these issues through short surveys and discussion forums conducted with selected participants in residency programs and professional meetings.
We look forward to obtaining your viewpoints.
Director of Research
Accreditation Council for Graduate Medical Education
American Medical Association
Chicago, Ill
Edited by Gloria Robertson, Department of Resident Physician Services, American Medical Association.
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