New Accreditation System Will Require Medical Residents to Show Skills and Traits

February 28, 2012

Medical-residency programs will be required to demonstrate that their trainees have the skills and personal attributes they need to be competent, empathetic doctors under a new accreditation system unveiled last week.

The changes, announced by the Accreditation Council for Graduate Medical Education, are designed to reassure a public that is increasingly complaining about medical errors and hurried, impersonal doctors.

The new system will also provide more regular, detailed feedback to medical residents, who will be assessed twice a year on how well they are mastering about three dozen skills and behaviors.

"Process is easier to measure—counting the number of surgical procedures someone does, how many patients he sees, how many teaching hours he receives," said Carol A. Aschenbrener, chief medical-education officer of the Association of American Medical Colleges, which supports the changes.

The new system will focus instead on outcomes—"the actual behaviors you should see in order to be confident that resident physicians are progressing to the point where they will be ready to practice on their own," she said.

The changes, which were described in an article in The New England Journal of Medicine, will be phased in over two years, beginning in July 2013.

The council will extend the time between site visits from the current four or five years to 10, but programs will have to submit annual reports documenting their progress on key performance measures.

Residents will be able to progress at their own pace, moving more quickly through the skills that come easily to them and spending more time and remediation in areas they find challenging.

Programs that are in good standing will have more freedom to tailor their training to the needs of their students and patients.

"We're not trying to create cookie-cutter doctors," said Thomas J. Nasca, the council's chief executive officer. The goal, instead, is to identify a set of core skills that physicians must master to show that they have the skills and behavior to be good doctors.

The specific skills, which are being developed by each medical specialty, will cover six core areas: patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. Programs will have to develop and publish specific learning outcomes that residents must demonstrate as they progress through training.

Some residency-program directors aren't yet sold on the idea. "My reservation about the milestones is that they could be so prescriptive that the reporting requirements will eat up a lot of administrators' time," said Stephen R. Baker, a radiologist who oversees 48 residency programs at the University of Medicine and Dentistry of New Jersey. "I'm taking a wait-and-see position."

One goal, according to Dr. Aschenbrener, might be reducing bloodstream infections caused when a doctor inserts a tube into a large vein to give medicine to a patient. Residents in a critical-care rotation would have to show tangible evidence that they could insert such a line safely.

Patients, nurses, and supervising physicians could be called on to help evaluate whether residents demonstrated empathy and good bedside manner.