ACGME core competencies: where are we?

Beginning in July 2002, the Accreditation Council for Graduate Medical Education (ACGME) instructed all residency programs to require their residents to demonstrate competency in 6 core areas: patient care, interpersonal and communication skills, medical knowledge, professionalism, practice-based learning, and systems-based practice. The goal was to have objective markers of performance that would serve as a gauge to determine a program's accreditation. To determine the experiences of orthopedic residency programs with regard to the ACGME's core competencies, a national survey was administered to orthopedic program directors and selected orthopedic residents. Of those orthopedic programs that responded, most appeared to be complying with the ACGME requirements. Both directors and residents thought patient care and medical knowledge ranked most important, while practice-based learning and systems-based practice were assigned the lowest ranks. Barriers to implementation of the core competencies included low priority compared with clinical duties, lack of faculty or resident education, and lack of formal orthopedic core competencies. Residents and program directors agreed that their programs would benefit from a definition of each of the core competencies, including a greater commitment to the processes involved in surgical procedures. This study demonstrated a commitment to the core competencies by the programs that responded. The survey also suggested this commitment would be aided by improved definitions of some of the competencies for the orthopedic resident.