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. Educators are also
responsible for assessing whether trainees are progressing appropriately toward
independence, and ultimately determining whether they are prepared for
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. 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,. In 2013, the Association
of American Medical Colleges (AAMC) further defined competencies for health
professionals, adding two new competency domains. 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
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.
 Frank, J. R., et al. (2010). "Competency-based
medical education: theory to practice." Med Teach 32(8): 638-645.
Holmboe, E. S., et al. (2010). "The role of assessment in competency-based
medical education." Med Teach 32(8): 676-682.
Swing, S. R. (2007). "The ACGME outcome project: retrospective and
prospective." Med Teach 29(7): 648-654.
 Nasca, T. J., et al. (2012). "The next GME
accreditation system--rationale and benefits." N Engl J Med 366(11):
 Caverzagie, K. J., et al. (2013). "The internal
medicine reporting milestones and the next accreditation system." Ann
Intern Med 158(7): 557-559.
 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.