Why are the ACGME competencies an issue now?

The concept of physician “competencies” is not new. Public and private foundations with an interest in health care had already defined numerous competencies in medical practice. In addition, the external stakeholders in the process, namely: 1) The “Market”, 2) The Government and 3) The “Public” had voiced increasing concerns about insuring quality among health care trainees and providers ^1-4

New challenges regarding the “business of medicine”, the maturity of managed care, and the continuing escalation of health care costs have also brought the “Market” into the educational process. The third party payers and insurance companies expect and demand professional competency across multiple domains. Likewise, the regulatory agencies from the “Government” have increased their oversight role as the watchdog for quality and cost effectiveness in medical education. The US medical education system is heavily dependent on public funding and the responsible stewardship and allocation of resources is implicit in the educational mandate. The Government has increasingly demanded more concrete evidence of efficacy in the form of educational outcomes. Finally, the modern health care consumer (the “Public”) is more likely to be knowledgeable about their illness and is more involved in their care. The “Public” demands transparency, accountability, responsibility, and “proof of quality.” The state and national certifying, accrediting, and professional organizations (including the American Board of Ophthalmology) serve the “public“ good as their primary mission. These certifying boards are designed to protect the public and have also adopted a competency model for certification and for maintenance of certification. The ACGME competencies were the result of internal and external pressure and criticism to develop a framework for the competencies using the principles of outcomes assessment.

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