Accreditation Council for Graduate Medical Education
ProfessionalismACGME’S PerspectiveIt’s a Competency
Marsha Miller, MA
Associate Vice President, Office of Resident Services
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My encounter with unprofessional
behavior—a mother’s story.
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“Residents must demonstrate a commitment
to carrying out professional responsibilities
and an adherence to ethical principles.
Residents are expected to demonstrate:
• Compassion, integrity, and respect for
others;
• Responsiveness to patient needs that
supersedes self interest;
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• Respect for patient privacy and autonomy;
• Accountability to patients, society and the
profession; and
• Sensitivity and responsiveness to a
diverse patient population, including but
not limited to diversity in gender, age,
culture, race, religion, disabilities, and
sexual orientation.”
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“Research has shown that medical students
often learn the values and ideology of the
profession by observing the behavior of
those in positions to which they aspire.
Through this process of observing, students
typically experience pressure to conform to
and adopt values and behaviors not
espoused by the formal curriculum as
normative characteristics of the physician’s
role (White, et al., 2009).”
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Residents underreport duty hours for three
reasons:
• They want to take care of their patients
and not hand them off;
• There is an unusual case to observe or
didactics scheduled;
• There is fear of losing accreditation and
having to find another program.
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“They (program directors) see it (resident
survey) as a threat because they may get
unfavorable responses (and sometimes
they do because residents don’t know how
to answer the questions).”
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• “Duty hours can be complicated. Do we
count weekends, backup call? If so, it
could look like they are always on call!”
• “Program directors know that the results of
the survey will be used by the ACGME
and their home DIO. We are all nervous
about the ACGME and DIO.”
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• “I don’t tell my residents what to say, but
do help them understand the nature of the
questions, and like duty hours, help them
answer it in a way that is realistic (E.
Beresin, MD, personal communication,
2009).”
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Three stories:
• ACGME resident survey
• Professional Misconduct
• Dismissal
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What are the objective measures?
• Internal Medicine, Pediatrics, OB/GYN,
Surgery, and Urology have formed
Milestone Groups.
• They have convened to define the
cognitive and behavioral attributes that are
essential.
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• Transitional Year, Radiology, and
Ophthalmology are beginning to form.
Each group includes:
• representative of the specialty board
• review committee member
• RRC executive director
• ACGME portfolio advisor
• one or two residents
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Eventually the milestones, assessment
tools, and common curriculum
components will be preloaded into
specialty specific versions of the ACGME
Learning Portfolio (ALP).
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• ALP will:
• Serve as the required repository for semiannual documentation.
• Aggregate the data and produce local and
national reports.
• Data collected will support program review
by the residency review committees and
improvement.
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• Accreditation review will transform from a
process-based system to a system in
which programs are periodically evaluated
and tracked based on aggregate
performance outcomes and compared to
national milestones and expectations.
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• RRCs will build longitudinal profiles of a
program’s educational performance,
including Professionalism.
• This will facilitate continuous monitoring of
outcomes, increased accountability to the
public, and prompt intercession when
difficulties arise.
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• A natural benefit will be the lengthening of
the duration between site visits.
• Data will be reviewed annually.
• No reason for a site visit if graduates
demonstrate proficiency in the
competencies, professionalism being but
one.
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How will this system work?
• Program Directors will enter the
information into ALP at least twice
annually.
• The RRCs will use the aggregate data for
program review and accreditation
decisions.
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What will this accomplish?
• Increased communication, consistency,
and an outcome-driven approach will
enable RRCs to streamline their review of
programs, offer timely guidance and
assistance, and extend site visits!
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• DIOS will benefit because they can use
the portfolios to assess how well programs
are doing within their institutions in
preparing competent physicians for
practice.
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In a nutshell—
• Residents will have objective path
markers.
• Program Directors will have measurement
tools.
• Program Directors will evaluate and
measure proficiency in the six
competencies.
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• Program Directors will enter the
information into ALP at least twice
annually.
• The RRCs will use the data for program
review and accreditation decisions.
• Programs will have extended time
between site visits.
• Program Directors and DIOs will be
happier! And so will we!
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The good news—
• We are making process in defining
competence markers and identifying tools
to measure Professionalism and the other
ACGME competencies.
The bad news—
• We have only just begun.
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• To learn more about ALP and the
Milestones and Outcomes Projects, please
visit the AGME Web site:
• http://www.acgme.org/outcome/about/faq.
asp
• http://www.acgme.org/acWebsite/portfolio/
alp_faqs.pdf
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Last thoughts…
Socrates said that an “unexamined life” is
not worth living.
We need to look inward and to do what is
right, not for one’s own benefit, but for the
rightness of it.
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Doctors are very familiar with these
concepts because they have taken an
oath to place the welfare of the patient
above their own because it is the right
thing to do.
In my opinion—This is Professionalism!
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