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
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

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 problemsolving, 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 “selfassessments” 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 outpatient resources effectively?
 Does the resident use practice guidelines
appropriately?

And the true challenge…
Strive not for
“competence” but for
excellence!