The ACGME timeline for implementing the new competencies places us all in the phase when providing evidence of resident learning in all six competencies is required. This phase extends from July 2002 through June 2006. Our review of the literature and our informal monitoring of comments by colleagues at surgical specialty society meetings suggest that many programs are still struggling with operationalizing and tailoring the competencies for their respective programs. Our local experience in addressing the practical issues of implementing and sustaining assessment and training initiatives for the competencies suggests that we all have much work left to do and much to learn. Although the ACGME timeline only requires programs to provide evidence of resident learning in all six competencies in this phase (extending through June, 2006), we believe programs will inevitably incorporate both learning and assessment initiatives, thus functionally combining ACGME phases 2 and 3. Phase 3 is scheduled for July 2006 through June 2011, and holds programs responsible for providing evidence of learning and assessment, and for using assessments for program improvement. The real payoff of this initiative lies in identifying best practices for the various competencies. This phase is scheduled for a period beginning in July, 2011. We believe that this process will occur sooner. We also hope that this initiative will result in a clearer picture of the relationship among training, surgeon practice, and patient outcomes, and in improved ability to produce sustainable changes in practice behavior that, in turn, lead to improved patient outcomes. The ultimate goal of the ACGME competencies project and the primary focus of phase 4, which begins in July 2011, is to allow the identification of benchmark programs and best educational practices, and to make information about these programs and practices available in a form that will help program directors and interested faculty better align their program resources and approaches in order to achieve their program goals and to improve effectiveness. This process is in the spirit of the Baldridge National Quality Program, which now has performance excellence criteria for educational organizations . Our review of the literature suggests that the ACGME competencies project can serve as a vehicle to promote sharing of useful information about training programs among program directors, and to stimulate program improvements. We look forward to learning from other programs as they follow the course laid out by the ACGME.
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