The future of residency education: Implementing a competency-based educational model

Graduate medical programs are faced with increasing calls for competency-based education. All accredited residencies and fellowships must now demonstrate that graduates are competent in six key areas, and outcomes data must be used to improve each program. The transition to competencybased education has challenged programs in all specialties. We describe the design, implementation, and outcomes measurement of a comprehensive, competency-based family medicine curriculum that uses multiple educational components and assessment tools in various settings and relies on both formative and summative feedback. Components include inpatient and outpatient core competencies, a longitudinal didactic curriculum, a competency-based procedures curriculum, and use of medical evidence to improve individual patient care in ambulatory practice. In addition to multiple evaluation tools (eg, video monitoring, rotation-specific evaluations, adviser-advisee meetings, faculty meetings, and checklist evaluations of procedures and physical examinations), residents receive feedback from patients, faculty, nurses, transcriptionists, and referring physicians. The curriculum demonstrates resident competence in six core areas and resident confidence in skills acquired by the completion of training. The evaluation system promotes greater objectivity in information provided to future employers and hospitals about residents. This model provides a curricular template for other accredited residency programs.