Quality of Care and Quality of Training: A Shared Vision for Internal Medicine?
- From American Board of Internal Medicine and ABIM Foundation, Philadelphia, PA 19106-3699.
Stark attention to health care outcomes has accompanied the increased scrutiny of quality of care and calls for accountability among all sectors of the health care world to demonstrate value, quality, safety, and professionalism. Competency, a primary outcome of medical education and training, is at the core of the way this quality revolution is expressing itself in the world of education.
Why Outcomes?
Structure and process were the earliest components of hospital and health plan accreditation, as they were for accreditation of training programs (1). Outcomes are harder to measure, but even decades ago, surgeons were holding themselves and their colleagues accountable to outcomes that were measurable even in the absence of sophisticated information systems, namely, surgical mortality rates and complication rates (2). Now, advances in health services research have begun to deliver on the promise of clinical outcomes measures that are valid and clinically meaningful.
The papers in this issue by Holmboe and colleagues (3) and Goroll and coworkers (4) extend this work into the world of medical education and training. Competencies are the product of education in the same way that clinical outcomes are a product of health care. The traditional test of education is knowledge. To this end, the examinations of the National Board of Medical Examiners, the Educational Commission for Foreign Medical Graduates, and the specialty boards of the American Board of Medical Specialties (ABMS) have developed highly rigorous, psychometrically sound approaches to testing medical knowledge, synthesis, and judgment. Working with ABMS, the Accreditation Council for Graduate Medical Education (ACGME) established a competency-based standard for medical training that became effective for all ABMS member boards in 2003. Training programs must now demonstrate that their graduates are competent in patient care, medical knowledge, practice-based learning and …
This 100-word excerpt has been provided in the absence of an abstract.
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