September 20, 2012

ACGME Core Competencies

Patient Care: Identify, respect, and care about patients’ differences, values, preferences, and expressed needs; listen to, clearly inform, communicate with and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.

Medical Knowledge: Established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social behavioral) sciences and the application of knowledge to patient care.

Practice-Based Learning and Improvement: Involves investigation and evaluation of one’s own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.

Interpersonal and Communication Skills: That result in effective information exchange and teaming with patients, their families and other health professionals.

Professionalism: Commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

Systems-Based Practice: Actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

I’m sure all of you who aren’t doctors are looking at this and saying, “What?” Allow me to explain. (Those of you who are doctors can skip this section. It probably contains things you learned in med school or residency. It quite possibly also contains things you’ve been thinking while reading previous posts.)

The ACGME is the Accreditation Council for Graduate Medical Education. It is different from but related to the umbrella body to whom I report. (CME is ultimately accredited by the ACCME, the Accreditation Council on Continuing Medical Education.) CME is for practicing physicians; GME is for resident physicians. In order to graduate from a residency program, doctors need to meet certain core competencies. In CME, we call these things “Desirable Physician Attributes”. If you read the above list, you can understand why. And you’re also probably thinking that my fertility specialist is lacking in some of these traits.

Let’s take Patient Care. I’m sure you’ve noticed that he’s pretty lousy when it comes to respecting my preferences, or listening to me, or sharing decision making. Or Interpersonal and Communication Skills. Would you call some of the exchanges I’ve described as “effective information exchange”? And then there’s Professionalism. He clearly lacks sensitivity.

In other words, he would not be doing well in meeting the Core Competencies if he were a resident today. He gets away with it because he’s been in practice for ages and there are so few specialists in his field that he has a near monopoly on it. (And I think I forgot to mention that he’s been known to call me by full name from the waiting room, a clear HIPAA violation. Not that I care. And the alliteration of my name can be irresistible. But he still should know better.)

Here’s the latest reason he made me think of the ACGME. (I should probably add that we have a large residency program where I work, so while my job is strictly CME, I spend a lot of time around GME people.) My period started on Tuesday, but I decided to wait until I got home yesterday afternoon to call. One day wasn’t going to make a difference. And the nurse I spoke to was charming and equally frustrated with the following as I was. He didn’t put anything in my chart about what day of my cycle I should come in. He had given me a prescription for Femara at my last appointment, and I’d filled it before vacation so that I’d have it if I needed to take it while at my brother’s, so at least that much had been taken care of. But he didn’t make a note of when I should go in. He didn’t make a note of whether or not I should do OPKs, let alone when I should take them. He’d, apparently, made no notes at all on what we were going to do for my next cycle. (Although I do think she asked if I’d been in for an FSH consult. I swear he’s trying to bully me into that treatment option. What was that about respecting patient’s preferences?) This is not the first time that his charting has been, to use the technical term, crap.

Anyway, I had my choice. Go in the day before going to Chicago for the weekend or go in the day after getting back from Chicago. I opted for the day after. Here’s hoping it’s not too late. In the meanwhile, it’s back on the Femara. Blech.


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