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Date Updated: November 9, 2011

Health System Reform Policies Appendix

Current Frameworks For Competence

The issue of the quality of healthcare providers at all levels is closely linked to the quality of healthcare, to clinical outcomes, and to the costs expended to achieve desired results. The Institute of Medicine6 estimated that 44,000 to 98,000 excess deaths in the United States and significant morbidity arise from the approximately three adverse events that occur for every 100 hospitalizations and attributed these to preventable deficiencies in the quality of healthcare provided. These preventable errors spurred intense national interest in how to make hospitals and healthcare organizations safer. In the ensuing decade, the performance of health systems and, by extension, the actions of professionals who provide healthcare therein has become a prime focus of efforts to improve quality and decrease errors.

Every organization charged with the responsibility of certifying professional competence has evolved its own methods of defining and assessing competence; however, Epstein and Hundert7 reported in 2002 that most current assessment formats used in medicine reliably test core knowledge and basic skills, but they may underemphasize such domains of medical practice as interpersonal skills, lifelong learning, professionalism, and the integration of core knowledge into clinical practice. The same is undoubtedly true for other health professions.

The Accreditation Council for Graduate Medical Education (ACGME) is charged with accrediting and evaluating residency programs throughout the United States and thus improving healthcare through assuring high quality resident education. The American Board of Medical Specialties (ABMS) represents the 24 specialty certifying boards in American medicine. The ACGME Outcomes Project was designed to measure actual outcomes of residency programs; part of this project was to define the general competencies required to prepare resident physicians to independently practice medicine. This definition was undertaken jointly with the ABMS8. The competency taxonomy developed through the Outcomes Project has subsequently been adopted and expanded for application to specialty certification and maintenance of certification, undergraduate medical education, and physician practice (see the Guide to Good Medical Practice – USA, described in "Current System Characteristics"). The six general competencies identified are: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professional behavior, and systems-based practice. While there are other competency schemes (Institute of Medicine competencies, AAMC Medical School Objectives Project, and the CanMEDS Physician Competency Framework, to name a few), the general competencies developed by ACGME/ABMS are being used extensively.

6 Institute of Medicine, To Err Is Human: Building a Safer Health System. 1999. Washington, DC: National Academy Press.

7 Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA, 2002:287(226-235).

8 For more information on the ACGME Outcomes Project, see http://www.acgme.org/.


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