Where did the ACGME competencies come from?

The “competency” model is an old concept that has been modified over time (January 1998 to February 1999) by the ACGME from various sources.^5-18 The Pew Health Professions Commission described specific “competencies” (Table 1). Other specialty organizations have developed similar lists including the Council on Graduate Medical Education (COGME), the Federated Council for Internal Medicine (Task Force on the Internal Medicine Residency Curriculum), the National Council of State Boards of Nursing, the American Association of Colleges of Osteopathic Medicine, and the American Academy of Family Physicians. Prior to the adoption of the ACGME competencies there had been at least nine separate major reports on physician competencies¹⁵ (Table 2).

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Table 1: Pew Commission 21 competencies for the 21st century
1. Embrace a personal ethic of social responsibility and service
2. Exhibit ethical behavior in all professional activities
3. Provide evidence-based, clinically competent care
4. Incorporate the multiple determinants of health in clinical care
5. Apply knowledge of the new schemes
6. Demonstrate critical thinking, reflection, and problem-solving skills
7. Understand the role of primary care
8. Rigorously practice preventive health care
9. Integrate population-based care and services into practice
10. Improve access to health care for those with unmet health needs
11. Practice relationship-centered care with individuals and families
12. Provide culturally sensitive care to a diverse society
13. Partner with communities in health care decisions
14. Use communication and information technology effectively and appropriately
15. Work in interdisciplinary teams
16. Ensure care that balances individual, professional, system, and societal needs
17. Practice leadership
18. Take responsibility for quality of care and health outcomes at all levels
19. Contribute to continuous improvement of the health care system
20. Advocate for public policy that promotes and protects the health of the public
21. Continue to learn and help others learn

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Table 2: The ten curriculum domains

1. Health care system overview
2. Population-based care
3. Quality measurement and improvement
4. Medical management
5. Preventive care
6. Physician-patient communication
7. Ethics
8. Teamwork and collaboration
9. Information management and technology
10. Practice management

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