(originally posted September 2020; updated January 2022)
Due to the disruption in the educational components of some graduate medical education (GME) programs caused by the COVID-19 pandemic, competency-based medical education (CBME) is even more crucial in assessing the clinical competence of residents and fellows. The ACGME partnered with the certifying Boards to develop the following recommendations grounded in core CBME principles for programs, program directors, and Clinical Competency Committees (CCCs) to follow while facing COVID-19.
The ACGME will share this information with the GME community and work with programs, program directors, CCCs, Review Committees, and certifying Boards during this period of disruption to learn about what works for the implementation of CBME over time.
Recommendations for Competency-Based Medical Education (CBME) during COVID-19
* The ACGME program requirement supporting each recommendation is noted in parentheses. The Common Program Requirements can be accessed on the ACGME website, here.
The ACGME offers these recommendations as residency and fellowship programs anticipate continued disruptions to education and training during the COVID-19 pandemic. This is a time of extraordinary pressure for everyone in health professions education. Despite this pressure, it is vital to keep the public interest in mind. These recommendations are offered as the minimum set of program criteria for guiding decisions about learner progression and readiness for graduation during this COVID-19 pandemic.
Traditional time-based or volume-based measures may not be fully achievable during this period. The current environment is not “normal,” and each program should use the principles of CBME and the guidance below to make informed decisions about advancement, graduation, and Board eligibility. Educational experiences may be modified or disrupted through alternative forms of education, such as virtual learning, deployment to another clinical rotation or activity (e.g., ICU, ED, wards, telemedicine), or by missing a traditionally required rotation. Also, qualifications for some specialty Boards may not be program requirements, but they are typically completed during a residency or fellowship (e.g., Fundamentals of Laparoscopic Surgery (FLS) or a research thesis) and each specialty should check with the respective certification board regarding any changes. Programs should work to ensure these important activities are also completed.
CBME principles and activities have grown over the years and are used to support an entrustment decision-making process that determines whether individual residents or fellows are ready to progress to the next stage in their professional career (Table 2). “Entrustment decision-making” focuses on the conscientiousness, trustworthiness, discernment, and competence of the resident or fellow. The demonstration of conscientiousness, trustworthiness, and discernment supports confidence in assessment outcomes. Entrustment is grounded in the patient and educational outcomes that a graduate can deliver on the Quadruple Aim. The Quadruple Aim simultaneously improves patient experience of care, population health, and health care provider work life, while lowering per capita cost.
Summary
GME programs continue to be disrupted by COVID-19. The ACGME recognizes that typical metrics, such as time, volume, and specific rotations completed, may be unavailable for all residents and fellows. The principles provided are the minimum required to make a defensible, high-stakes entrustment decision for an individual to complete a residency or fellowship and advance to the next stage of one’s professional career during this period of disruption. It is possible that these principles will inform future CBME decisions using more robust and deeper data. The ACGME will work with programs, CCCs, the Review Committees, and ABMS certifying Boards during this disrupted period to learn about what works for the implementation of CBME over time.
Table 1. Core Competencies and Examples of Minimal Required Competency-Based Assessments that Could be Used during COVID-19 Disruption |
|
Competency |
Competency-Based Assessment Options |
Medical Knowledge |
|
Patient Care |
|
Professionalism |
|
Communication |
|
Practice-Based Learning and Improvement |
|
Systems-Based Practice |
|
Table 2. Van Melle Framework for Competency-Based Medical Education1 |
|
Component |
Description |
An Outcomes-Based |
|
Progressive Sequencing of Competencies |
|
Learning Experiences |
|
Teaching Tailored |
|
Programmatic Assessment |
|
1E. Van Melle, J.R. Frank, E.S. Holmboe, D. Dagnone, D. Stockley, and J. Sherbino (International Competency-Based Medical Education Collaborators). 2019. "A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs." Academic Medicine 94 (7):1002-1009. |
ACGME Resources to Support Competency-Based Medical Education Assessment
Milestones Guidebook (Second Edition)
Milestones Guidebook for Residents and Fellows (Second Edition)
Clinical Competency Committee Guidebook (Third Edition)
See also the CCC Guidebook Executive Summaries
Milestones Implementation Guidebook
Faculty Development in Assessment
ACGME Developing Faculty Competencies in Assessment course
Courses will be offered in May, October, and November 2022.
Developing Faculty Competencies in Assessment Online Mini-Course
National Milestones Reports
2021 Milestones National Report
This report contains descriptive data about Milestones ratings across all programs by specialty.
2021 Milestones Predictive Probability Values Report
This report provides predictive probability value (PPV) tables for almost all specialties with instructions on proper use of PPVs.
Contains research to date (updated annually).
ACGME Milestones and Assessment Resources web page
The ACGME provides two open-access assessment tools that may be of use for programs: