Harvard Macy Institute addresses the ACGME learning curve

The Accreditation Council for Graduate Medical Education (ACGME) in the U.S. has defined six competencies to guide professional development of residents and postgraduate fellows. The competencies, which went into effect in July 2002, may seem obvious at first, but academic medical centers are being challenged to develop curricula and methods of assessment that clearly chart a course of development that can be used to improve physicians’ competency for independent practice.

Teaching competencies can be a difficult task for qualities that have not always been explicitly taught or evaluated in the curriculum. (For an example, see the accompanying article on one of these competencies, professionalism). To help fill this need, the Harvard Macy Institute has designed an exercise for the May session of the Program for Physician-Educators that will lead to the creation of a “teaching toolbox” that can be used to integrate these criteria into curricula.

Dr. Tom Aretz, international director of medical education at HMI, who is leading this part of the Harvard Macy program, says that the exercise will “attempt to provide the connection between the criteria that the ACGME has set and the methods for assessing how those criteria have been met.” ACGME has already established strategies for assessing the competencies, but academic medical centers have been more or less left to their own devices when it comes to developing curricula to teach them. Dr. Elizabeth Armstrong, director of the Harvard Macy Institute, said that this May’s group “will develop a toolbox of teaching strategies that will hopefully complement the ACGME assessment strategies."

The teaching toolbox will be made available in two ways following its completion. The scholars themselves will likely help to disseminate these teaching strategies to their colleagues as they lead curriculum development projects in their own institutions. In addition, the teaching toolbox will reside on an intranet that the Institute is currently building to support the Harvard Macy alumni community. On this website, scholars will be able to post information about projects they’ve undertaken, access information about courses, and exchange contact information with their colleagues. In this way, the exercise from the course will produce “a living, growing toolbox for each of the six competencies," said Armstrong.

The exercise calls for physician-educators to draw upon their own experience. Before arriving for the May session, each participant will have studied a lengthy case study that illustrates many of the ACGME competencies. The participants will be asked to think of ways to teach the competencies addressed by the case study; when they convene in May, the physician-educators will be divided into six groupsæeach focused on one of the ACGME main competenciesæand design a set of pedagogical strategies, keeping in mind the ACGME’s criteria for assessment.

This exercise serves dual purposes that reflect the process of curriculum development. First, the scholars create a product as a group that will serve everybody. Second, they receive some important practice taking very concrete objectives and outcome metrics and designing the strategy that takes them from goals to outcomes, in this case the content of the teaching toolbox. For physician-educators, this skill is crucial to effecting change in curricula.

The ACGME is responsible only for accrediting postgraduate medical education programs in the United States. But Aretz pointed out that the teaching toolbox that comes out of the Harvard Macy program, of which a sizable percentage of the participants are from outside the U.S., will be applicable globally. “The ACGME competencies have a 90 percent overlap with many of the competencies listed in recent publications by professional organizations or regulatory bodies around the world,” said Aretz. “So programs that use these teaching strategies will be addressing their requirements.”