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Graduation Level Competencies for the School of Medicine

Task Force to Continue Work in Implementing Competencies across the Curriculum

Medical education provides students, residents and fellows with the opportunity to learn and practice in a supervised work environment so that they can acquire the knowledge, skills, attitudes and behaviors necessary to treat patients independently within the scope of their medical discipline. In a competency-based system of training, outcomes are derived from the abilities and standards required of physicians for safe and effective practice. Educators, informed and guided by the needs of patients and learners, provide the framework, curriculum, instruction, and supervision for this training[1]. Educators are also responsible for assessing whether trainees are progressing appropriately toward independence, and ultimately determining whether they are prepared for unsupervised practice[2].

The Accreditation Council for Graduate Medical Education (ACGME) introduced the Outcomes Project in 1999, requiring resident training programs to assess trainee accomplishment of learning objectives across six general domains of competence[3]. The Next Accreditation System of the ACGME began this year, and includes competency-based reporting using milestones, a criterion-based developmental framework for reporting a resident’s progress toward independent practice[4],[5]. In 2013, the Association of American Medical Colleges (AAMC) further defined competencies for health professionals, adding two new competency domains[6]. These domains have subsequently been adopted by the Liaison Committee for Medical Education (LCME), the accreditation body of medical schools. Integration of these competencies into medical student education is a required element for LCME accreditation.

A task force of the Curriculum Steering Committee, consisting of 16 faculty with expertise in competency development and spanning the continuum of medical education has worked for the last year to develop graduation level competencies for the University of Colorado School of Medicine. These competencies describe the minimum expectations required of a student prior to graduation from this medical school.

To develop the competencies, they reviewed the extensive literature, including the milestones of all specialties currently available. They developed draft competencies for each competency domain. These were reviewed iteratively using a modified Delphi technique. The final competencies were approved by the Clerkship Block Directors and the Curriculum Steering Committee in May, and presented in total for assent by the Faculty Senate. (View the final version of the competencies.​)

There is much work still to be done—this is only the first step. Over the next two years, the task force will be mapping the competencies to course and block level goals and objectives and assessments. In addition, "hard stops” at each phase of medical school will be identified with associated assessment tools. The work of the committee will be critical to the upcoming LCME self-study and accreditation process. 

[1] Frank, J. R., et al. (2010). "Competency-based medical education: theory to practice." Med Teach 32(8): 638-645.


[2] Holmboe, E. S., et al. (2010). "The role of assessment in competency-based medical education." Med Teach 32(8): 676-682.


[3] Swing, S. R. (2007). "The ACGME outcome project: retrospective and prospective." Med Teach 29(7): 648-654.


[4] Nasca, T. J., et al. (2012). "The next GME accreditation system--rationale and benefits." N Engl J Med 366(11): 1051-1056.


[5] Caverzagie, K. J., et al. (2013). "The internal medicine reporting milestones and the next accreditation system." Ann Intern Med 158(7): 557-559.


[6] Englander, R., et al. (2013). "Toward a common taxonomy of competency domains for the health professions and competencies for physicians." Acad Med 88(8): 1088-1094.