Competency Based Residency Training: the Next Advance in Graduate Medical Education

Abstract

The goal of all graduate medical education is to provide competency to practice in the chosen field of medicine. The evaluation of competency to practice, however, has never been clearly defined. Traditionally, resident competency has been measured by the certifying opinion of the program director that the trainee is ready to practice independently, after a specified number of years-in-training. This opinion may be supplemented by required examinations during training, and is expected to be supported by successful completion of a specialty board examination. However, there is no date available which verifies the ability of any of the three methods to predict competent, ethical practice. Whereas it is axiomatic that physicians should be skilled in the procedures they perform, how to ensure mastery of procedural skills is still a matter of much discussion. Even in specialities like surgery, where a number of required procedures can be specified, the evaluation of how well these procedures are performed, and perhaps even more important, whether the trainee can apply the skills learned in the overall treatment of individual patients, remain unresolved. In this report I suggest that the next major advance in graduate medical education should be the transition from the current years-in-training to competency-based training, in which each trainee has been shown to have acquired the skills and knowledge needed for his/her specialty, and can apply these skills independently and competently to individual patients. Certification of competency should replace the yearsin-place measure of residency training [8, 9].