Criteria for Excellence | Chapter 8D: Competency-based medical education
- On this page
- Understanding competency-based medical education
- Core components of competency-based medical education
- Develop an outcomes-driven program of assessment
- Use Entrustable Professional Activities (EPAs) in resident education
- Use entrustment to assess resident progression
- Align CBME with the core outcomes of family medicine residency training
- Use individualized learning plans to guide resident development
- Build a robust resident evaluation and assessment system
- Competency-based medical education evaluation resources
Use outcomes, assessment and individualized learning to advance resident competency.
Authors: Roger Garvin, MD; Randy Pearson, MD and John Gazewood, MD
Understanding competency-based medical education
Competency-based medical education (CBME) is an outcomes-based approach to education that moves the focus away from skill measurement based on time spent training, knowledge acquisition, and proxy assessments and toward considerations of time as a resource, knowledge application, and authentic assessments of real-world activities.
Table 1 shows the five core components of CBME. The central concept of this approach is starting with the end in mind. Therefore, a program of excellence focuses on what abilities a physician graduate will have and specifies these abilities in a clear, unambiguous way that can be understood by learners, faculty, and patients. The program’s curriculum, assessment process, and entire learning environment will flow from this understanding.
Since each graduate has individualized, personal goals, the abilities they will have are also individualized. However, a program of excellence has a process in place to recognize the individual goals of residents while also ensuring the competence of all graduates.
Core components of competency-based medical education
Table 1. Van Melle Framework for Competency-Based Medical
Education
| Component | Description |
| An outcomes-based competency framework |
|
| Progressive sequencing of competencies |
|
| Learning experiences tailored to competencies in CBME |
|
| Teaching tailored to competencies |
|
| Programmatic assessment (i.e., Program of Assessment) |
|
The evolution of CBME in graduate medical education
Over the last 25 years, medical education has been moving toward CBME. The adoption of Entrustable Professional Activities (EPAs) in undergraduate medical education is one example of this shift. EPAs are descriptions of actual tasks that physicians do in the real world. (See the Components of CBME section for additional information.)
The process of incorporating CBME into graduate medical education (GME) started in 1998 with a call to train to competency that led to the 1999 introduction of six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies3:
- Patient Care
- Medical Knowledge
- Interpersonal and Communication Skills
- Professionalism
- Practice-Based Learning and Improvement
- Systems-Based Practice
These were followed by specialty-specific subcompetencies and associated Milestones. The subcompetencies and Milestones for family medicine were revised to a second iteration—Milestones 2.0—that went into effect on July 1, 2020.4
All residents are assessed using the subcompetencies and Milestones twice a year, and the results are reported to the ACGME and shared with residents. The information in the semiannual ACGME Milestone Reports is primarily used for program improvement. However, residencies employing CBME seek to use these program-level data to develop individualized progress reports that can track each resident’s progress toward the end goal of residency education: the ability to practice family medicine independently in all settings.
Develop an outcomes-driven program of assessment
The assessment program is a structured process within the educational program. It is multisource and grounded in assessment that is as close to the real world as possible.
Since CBME starts with the end in mind, assessment is described first or very early in the process of curriculum development. This ensures that the curriculum’s outcomes are meaningful to residents, faculty, and patients.
Rather than assuming competency in the context of time-based educational experiences, a program of excellence establishes metrics to assess true competency in the context of performance. A variety of means for program faculty to assess competency are available. While the gold standard for assessing competency is direct observation using scales such as the scale of entrustment, other data sources should become part of the overall assessment.
In order to participate optimally in CBME, residents must be able to engage in accurate self-assessment. This is not a natural skill, so it will need to be instilled in residents and assessed, as will their ability to understand that being “not yet competent” for a task is not an assessment of their worth or skill as a physician. It is simply a descriptor of their current status along a continuum of competence.
Prepare faculty for outcomes-driven assessment
Much like the implementation of ACGME Milestones represented a clear shift in focus for residency education, the movement toward CBME requires a program of excellence to invest significant time and resources into developing faculty skills in the use of assessments for resident advising and coaching.
The in-person ACGME course “Developing Faculty Competencies in Assessment” is one resource that programs can use to begin this development process. In addition, the ACGME offers a complete faculty toolkit on developing assessment skills at Learn at ACGME.
Implementation of CBME and a program of assessment also requires faculty training on EPA development and consistent entrustment decisions. This is not just “writing rotation documents in competency language.” It requires deep thought about the exact real-world skills residents must develop and demonstrate for each part of the curriculum. The Society of Teachers of Family Medicine (STFM) task force on CBME has compiled assessment tools and strategies as part of its Competency-Based Medical Education Toolkit for Residency Programs.
Use Entrustable Professional Activities (EPAs) in resident education
Core competencies, subcompetencies, and Milestones describe the knowledge, skills, and attitude required to be a family physician but not the actual work of being a family physician. A competency can be assessed by an examination, but residents must actually perform certain tasks to be assessed on EPAs.
In addition, EPAs more clearly communicate to learners, educators, employers, and society what skills a family physician is expected to have. Thus, programs of excellence are encouraged to use EPAs in the creation of their educational program and to stress the concepts of CBME throughout the residency.
As descriptors of a family physician’s activities, EPAs are a natural starting point for developing individualized learning plans (ILPs) for all residents. Linking EPAs to Milestones can provide faculty members and residents with more specific, observable behaviors to inform educational plans that will help residents attain entrustment in specific EPAs.
In resident remediation, EPAs can be used to clarify areas of needed improvement for both the resident and faculty. Ideally, this will allow earlier identification of residents who are “falling off the curve” of progression of skills.
Use EPAs for communication, assessment and curriculum development
Programs can also use EPAs to do the following:
Communicate to faculty, community preceptors, residents, and staff about key tasks to be learned in a family medicine residency: EPAs use language that is clearer and more natural than the language used for subcompetencies and Milestones.
Create meaningful assessments using EPA language: It is easier for faculty members to use EPA language for assessments because the process of entrustment is more intuitive than trying to assign Milestone levels.
Create new curriculum and evaluate current curriculum: Since EPAs describe the ultimate work of being a family physician, residency programs should include EPA language in any new curriculum being developed. Current curriculum should be evaluated to determine how completely the skills described by the EPAs for family medicine are addressed.
Use entrustment to assess resident progression
In traditional assessment, programs relied on a “gestalt” impression of resident performance. Rather than being based on actual measures of performance, the impression was often shaped by the assessor’s previous experiences with other residents. In some cases, the resident's likeability may have figured heavily into the evaluator’s ratings.
By contrast, in competency-based assessment, the assessor relies on concrete measures of the resident’s ability to perform required curricular elements. The goal is to ensure the resident’s progression toward independent performance of the measured task.
Evaluation should be directed toward entrustment of the resident for independent practice using scales such as the following:
- Observation only
- Act under direct supervision
- Act under indirect supervision
- Act independently with clinical oversight (independent practice)
- Supervise others
Entrustment decisions are dependent on the context of observation (e.g., time of day, facilities available) and may be affected by a number of factors, including trainee and supervisor attributes and the nature of the EPA (e.g., rare and complex versus common and easy)(Table 2).
In addition, factors that enable entrustability include the resident’s ability (i.e., level of knowledge, skills, and attitude), conscientiousness, truthfulness (i.e., truth-telling and absence of deception), and discernment (i.e., knowledge of one’s limits and willingness to seek help).
Table 2 identifies factors affecting entrustment decisions, including trainee attributes, supervisor attributes, care setting, EPA type and program setting.
Table 2. Factors that affect entrustment decisions
| Trainee attributes |
|
| Supervisor attributes |
|
| Care setting |
|
| Entrustable Professional Activity (EPA) type |
|
| Program setting |
|
A program of excellence may choose to use EPAs created externally, such as those developed by Family Medicine for America’s Health. However, programs are encouraged to create their own EPAs to facilitate the CBME process.
Characteristics of a good EPA include the following:
- Describes an important routine care activity that defines the specialty or subspecialty.
- Is observable and measurable.
- Requires an integration of competencies within and across domains to perform.
- Allows residents to be deemed “entrustable” based on their readiness to safely perform the activity without supervision.
Table 3 provides guidelines for creating EPAs that are clear and detailed enough to effectively set residents’ expectations and guide assessors’ entrustment decisions. One possible approach to developing program-specific EPAs is to use the proposed core outcomes of residency training as a framework.
Table 3. Components of an EPA
| Title | Make it short; avoid words related to proficiency or skill. Ask yourself: Can a trainee be scheduled to do this? Can an entrustment decision for unsupervised practice for this EPA be made and documented? |
| Description | To enhance universal clarity, include everything necessary to specify the following: What is included? What limitations apply? Limit the description to the actual activity. Avoid justifications of why the EPA is important or references to knowledge and skills. |
| Competencies | Which competency domains apply? Which subcompetencies apply? Include only the most relevant ones. These may serve to build observation and assessment methods. |
| Required knowledge, skills and attitude |
Which KSAs are necessary to execute the EPA? Formulate this in a way to set expectations. Refer to resources that reflect necessary or helpful standards (books, a skills course, etc.). |
| Information to assess progress | Consider observations, resident work products, monitoring of knowledge and skill, and multisource feedback. |
| When is unsupervised practice expected? | Estimate when full entrustment for unsupervised practice is expected, acknowledging the flexible nature of this. Expectations of entrustment moments can shape an individual workplace curriculum. |
| Basis for formal entrustment decisions | How many times must the EPA be executed proficiently for unsupervised practice? Who will judge this? What does formal entrustment look like (documented, publicly announced)? |
Align CBME with the core outcomes of family medicine residency training
In 2023, the American Board of Family Medicine (ABFM), ACGME Family Medicine Review Committee, and other stakeholders developed 12 “core outcomes” to describe the broad scope of what graduates should be able to do when they complete family medicine residency training.
Although the ABFM decided not to call these outcomes EPAs, all of the components of EPAs described in Table 3 also apply to the core outcomes. The ABFM subsequently identified additional outcomes focused on robust continuity of care and specific aspects of the care of pregnant people and children. It also proposed a three-year time frame for phasing in reporting on the attainment of each outcome by individual residency graduates.
Define the desired outcomes of family medicine residency
The desired outcomes of ACGME-accredited training in family medicine include the ability to:
Practice as personal physicians, providing first contact, comprehensive and
continuity care, to include excellent doctor-patient relationships, excellent care of chronic disease and routine preventive care and effective practice management.Diagnose and manage acute illness and injury for people of all ages in the
emergency room or hospital.Provide comprehensive care of children, including diagnosis and management of
the acutely ill child and routine preventive care.Develop effective communication and constructive relationships with patients, teams and consultants.
Model professionalism and be trustworthy for patients, peers, and communities.6
Practice as personal physicians, to include care of women, the elderly, and
patients at the end of life, with excellent rate of continuity and appropriate
referrals.Provide care for low-risk patients who are pregnant, to include management of
early pregnancy, medical problems during pregnancy, prenatal care, postpartum
care and breastfeeding, with or without competence in labor and delivery.Diagnose and manage common mental health problems in people of all ages.
Perform the procedures most frequently needed by patients in continuity and
hospital practices.Model lifelong learning and self-reflection.6
Practice as personal physicians, to include musculoskeletal health, appropriate
medication use and coordination of care by helping patients navigate a complex
health system.Provide preventive care that improves wellness, modifies risk factors for illness
and injury, and detects illness in early, treatable stages for people of all ages
while supporting patients’ values and preferences.Assess priorities of care for individual patients across the continuum of care — in-office visits, emergency, hospital, and other settings, balancing the preferences of patients and medical priorities.
Evaluate, diagnose, and manage patients with undifferentiated symptoms, chronic medical conditions, and multiple comorbidities.
Effectively lead, manage, and participate in teams that provide care and improve
outcomes for the diverse populations and communities they serve.6
For assessment strategies for each outcome, see the Journal of the American Board of Family Medicine article “Implementing Competency Based ABFM Board Eligibility.” Other assessment strategies and tools are discussed at the end of this section.
Use individualized learning plans to guide resident development
The revised program requirements for family medicine residency education call for an ILP for each resident. The goal of this requirement is to start the process of developing a master adaptive and lifelong learner.7
A resident’s ILP should be reviewed regularly by the resident and faculty to assess progress and revise both the document and educational activities.
An ILP should address all of the following:
Resident goals and needs: Accurate self-assessment, accepting of assessment of others.
Program needs and mission: Milestones, etc.
Institution needs and mission: Should align with the program and vice versa.
ABFM core outcomes: How will resident activities help achieve these?
Build effective individualized learning plans
The ACGME states the following regarding ILPs:
An ILP should be formulated by the learner, should include personal learning
objectives, and should identify resources and strategies to achieve them. While the learner should be able to create an initial ILP, the ILP content should be guided by a facilitator (faculty member, associate program director, or program director). The draft ILP created by the resident can provide enormous insight to the program director and/or [Clinical Competency Committee]. The information contained in the ILP is one major way to determine if the learner can honestly self-reflect based on feedback, and has the insight required to be successful in remediating. Learners should be actively engaged in creating an ILP to take ownership of their own learning. ILPs allow learners to focus on priority areas, re-evaluate learning needs, identify measures of success, and have regular discussions about achieving learning goals.8
Further, the ACGME’s executive summary on ILPs provides the following description:
Reflection on goals and honest self-assessment of strengths and weaknesses
Generation of goals, which should include focus on the Core Competencies
Explicit plans or strategies to achieve each goal
Description of the assessment method or tool that will be used to measure
progress on each goalEventual revision of goals or creation of new goals based on performance
An identified faculty facilitator
Tools for every resident/fellow
Formulated by the individual (resident/fellow)
Guided by a facilitator (faculty member, associate program director, or program
director)An exercise in self-assessment and self-reflection;
Iterative
A requirement
An indicator of insight and ability to become an independent lifelong learner.
Set in stone — they can and should be revisited by both the learner and the
facilitatorA portfolio
Evaluations
Created by faculty members or the program.8
Monitor and update individualized learning plans
An ILP must be developed for each resident who matriculates into the residency program, and it must be reviewed and updated at least semiannually by the resident and their advisor or the program director (PD).
Each resident must meet with a faculty advisor at least every six months to review their existing ILP, current progress and concerns, and preparations for future learning and career opportunities.
This meeting should include review of:
All formative and summative evaluations compared with program goals and
objectives.The resident’s Milestone attainment
All relevant clinical data, including volumes and quality performance metrics
Teaching evaluations
Participation in scholarship, quality improvement, health system committees and community engagement
In addition, faculty advisors must work with residents to help them develop professional and personal learning goals that can be achieved during residency, as well as postgraduation goals. Aspirational goals should be encouraged but must be tempered by the reality of residency.
Prepare faculty to coach residents through ILPs
It will take some time for residents and faculty to become comfortable with the ILP process. In particular, faculty will require significant professional development regarding ILPs.
One strategy is to have each faculty member develop their own ILP with feedback from peers. Faculty will need to be well versed in the residency program’s mission, competencies, Milestones, and core outcomes and be able to clearly articulate these to residents. They will also need guidance on how to create SMART (specific, measurable, achievable, relevant, and time-based) goals with residents. In particular, faculty members must be able
to help residents concretely define objective measures of success in fulfilling their ILP. The STFM Resource Library offers one example of an ILP outline.
Development of ILPs requires a paradigm shift on the part of residency faculty. Faculty members are familiar with the role of an advisor who reviews residents’ progress toward goals (e.g., academic goals, future practice plans) and suggests future rotations/experiences and the role of a mentor who guides and supports residents based on personal experience. These roles are supportive, but they do not provide the resident-centered focus necessary for developing and using ILPs. Rather, the appropriate faculty role is that of a coach who requires each resident to begin and maintain the process of development as a family physician.
Coaching is a resident-driven process that includes:
Reflection on past experiences
Problem-solving
Performance-based educational process
A successful faculty coach works with the resident to reflect on successes and challenges, create goals, solve problems, identify resources and develop and execute plans.
Build a robust resident evaluation and assessment system
To ensure that its graduates have attained the ABFM’s proposed outcomes of residency education, a program of excellence has a robust assessment system.
The ABFM estimates that the average family medicine graduate from a U.S. residency has between 50 and 75 assessments over three years of residency.9 By contrast, the average family medicine graduate from a Canadian residency will undergo over 1,000 assessments throughout two years of training.
While the “right number” of assessments needed to document competency upon completion of training is not clear, it is likely much closer to the number in the Canadian assessment system than the number in the current U.S. system. Getting to that level will require gradual development and use of tools until the program approaches at least daily assessment of each resident.
Use feedback to drive resident learning
In CBME, assessment drives learning. Trainees attend to areas in which they are assessed, and feedback from these assessments leads to improved performance.
Residency programs are responsible for providing learners with feedback on a regular basis. Feedback powers the learning cycle, allowing residents to reflect upon their performance, compare it to their goal, and adjust it to attain their goal.
Modern feedback models view feedback as a conversation between a trainee and a faculty member that facilitates the learner’s self-awareness and self-efficacy in identifying improvement objectives and strategies for achieving them. Programs of excellence use feedback models shown to be effective in improving trainee performance (e.g., ADAPT [Ask-Discuss-Ask-Plan Together] and R2C2 [Relationship, Reaction, Content and Coaching]).
Use formative and summative evaluations
Programs have a duty to monitor resident learning and performance on an ongoing basis to facilitate resident progress (i.e., formative evaluation) and provide a determination of where residents are along the continuum of their residency program experiences (i.e., summative evaluation).
Programs of excellence use both formative and summative evaluations to guide resident performance. It is useful for faculty and residents to review and reflect upon both types of assessment when developing and revising ILPs. In addition, the Clinical Competency Committee (CCC) uses these evaluations to assess a resident’s progress on the ACGME Milestones.
Formative evaluations are provided consistently to help residents learn to identify their strengths and weaknesses in providing patient care and determine educational opportunities to target areas that need work. These evaluations help programs identify areas in which residents need help so they can intervene immediately. Formative feedback should be specific and timely. It can be provided at a daily, case-based, or mid- and end-of-rotation frequency.
Summative evaluations assess a resident’s learning by comparison to the goals
and objectives of the rotation and program and, ultimately, to the core outcomes of residency training. Examples of summative evaluation include assessments of
whether a resident “passed” a rotation, whether a resident is ready to serve as a
supervisory resident, and whether a resident is ready for promotion to the next
postgraduate training year. Summative evaluations encompass all ACGME
competencies.Rotation evaluations include both formative and summative components. Every
block rotation must have an evaluation, and residents should have access to these 80 evaluations. Longitudinal experiences (e.g., continuity clinic) require evaluations every three months.
Assess resident knowledge, skills and attitudes
Residents should have evaluations that address their knowledge, skills, and attitude in all curricular areas. A program of excellence maps these evaluation domains to curricular components to ensure that the necessary knowledge, skills, and attitude are taught.
It also ensures that residents demonstrate the knowledge, skills, and attitude required for independent practice by mapping these domains to the outcomes of family medicine residency training and all EPAs developed by the program.
- Knowledge: Evaluation of a resident’s learning and study skills includes an
assessment of their ability to acquire, organize, access, and retain knowledge. - Skills: This evaluation domain includes assessing the following
skills:- History and physical examination
- Clinical reasoning
- Organization and time management
- Procedural
- Technology and data management
- Critical appraisal and evidence-informed decision-making
- Practice management (e.g., coding, billing, management principles, quality improvement, population management)
- Interpersonal communication, education, and advocacy
- Attitude: Evaluation of attitude includes assessing the following for each resident:
- Self-awareness
- Openness and response to feedback
- Commitment to excellence, growth, learning, and professionalism
- Willingness to work effectively as a member of an interprofessional team
- Commitment to community engagement and health equity
Use the Clinical Competency Committee to assess progress
The CCC is responsible for assigning each resident a Milestone rating for each subcompetency. A resident’s level of Milestone attainment is determined by developing a consensus of experienced faculty based on all of the assessment data available for the resident.
The CCC must provide this information to the PD on a semiannual basis. The PD or designated faculty member must then use the information to help residents develop ILPs.
Programs of excellence ensure that residents address their ILPs on at least a
semiannual basis. Furthermore, through their CCC, programs of excellence develop or modify evaluation tools so they can better assess resident attainment of Milestone competencies and identify curricular areas in which residents need improvement (i.e., consistently underperform in attaining expected Milestone levels). The CCC should also assess residents’ progress toward achievement of the core outcomes of family medicine residency training and provide guidance to help the PD determine when the resident has
achieved these core outcomes.
Select and use effective resident evaluation tools
A variety of effective, validated evaluation tools are available to residency programs. Tools that use criterion-based standards that describe the range of observable and expected behaviors (e.g., the Patient-Centered Observation Form) are particularly useful for evaluation.
A program of excellence is familiar with a range of validated evaluation tools and employs multiple tools based on the program’s available resources, the faculty’s training, and learners’ needs.
It is important to note that the Milestones themselves should not be used as an evaluation tool. Rather, all evaluation tools should be mapped to the Milestones to ensure that all subcompetencies and associated Milestones are assessed.
Faculty development in the use of evaluation tools is critical. The faculty member who completes the evaluation tool is the real instrument; the tool itself is simply a means of capturing their measurement. Faculty members are the primary source of inter-rater variability in evaluation. Programs of excellence provide faculty with ongoing training in the use of the program’s evaluation tools to ensure that they have a shared mental model of the behaviors evaluated by the tools and how to use the tools to evaluate those behaviors.
Use multiple sources of assessment data
Other key considerations regarding evaluations and assessments include:
Narrative data: Narrative data recorded on evaluation forms can provide important information for CCC members assigning Milestone levels. These data also provide residents and faculty with useful descriptive information to guide growth and learning. Programs of excellence maximize opportunities to collect narrative evaluations that describe residents’ performance.
Direct observation: There has been growing recognition of the power and necessity of direct observation as an assessment tool. It should be performed frequently by faculty directly observing care either in person or remotely using technology (e.g., via video observation or recording).
Interpersonal communication skills: Observational data from residents’
interactions with patients, as well as data from recorded or other directly observed patient care encounters, should be provided to residents to help them improve their performance. Providing residents with timely feedback regarding performance in all behavioral science areas allows for early and continued performance improvement. In promotion deliberations, the weighting of evaluation strategies for resident performance in all behavioral science-related curricula and competencies should be consistent with the weighting for other curricular areas. Assessment of interpersonal communication skills should include patient satisfaction scores.Multi-rater perspective: A program of excellence obtains evaluations from a 360-degree perspective. These evaluations may come from staff, other residents, attending physicians, and rotation preceptors. In addition, patient satisfaction surveys can provide important information to residents and assessors.
Clinical performance: Evaluation should also include performance data, such as time to chart closure, patient panel quality metrics, and patient volume and coding distributions. Chart reviews and chart-stimulated recall also provide assessors with important information regarding residents’ management of patients and clinical decision-making. A portfolio is a useful way to gather additional data (e.g., completion of scholarly projects, training certificates, lectures provided by the resident) to inform a well-rounded evaluation of the resident’s performance.
Resident well-being and resilience: Physician well-being affects the quality of
clinical care. Patients cared for by physicians suffering from burnout have worse quality outcomes than patients who receive care from physicians who are not burned out. In addition, it is estimated that hundreds of physicians, including students and residents, commit suicide each year.10 Programs of excellence recognize the complex interplay between personal wellness, clinical care, and level of educational engagement, and they regularly assess resident well-being. They also demonstrate measurably high levels of resident and faculty well-being through a combination of education and intentional system redesign. (See the Resident and Faculty Well-being chapter for additional information.)In-training assessment: The ABFM administers the In-Training Examination (ITE),
and the American College of Osteopathic Family Physicians (ACOFP) administers
the In-Service Exam (ISE). The ACOFP also offers the shorter 75-question Clinical Osteopathic Recognition Training Examination (CORTEx) as an alternative to having osteopathic residents take both the ITE and the ISE. Taking the ITE and the CORTEx allows residents in programs with Osteopathic Recognition status to meet the ACGME requirement that a formative exam must be conducted.
Use in-training exams to support resident and program improvement
These standardized objective evaluation methods deserve special attention. They can be used as an evaluation mechanism to help the program and the resident design and improve the resident’s individual experience.
In addition, performance on the ABFM-administered ITE has strong positive predictive value for future performance on the ABFM certification exam.11 (A Bayesian Score Predictor is available from the ABFM.) Thus, the data should be provided to the resident and made part of an ILP.
Programs of Excellence also utilize data from the ITE or ISE, along with ABFM or ACOFP certification examination results, to evaluate the effectiveness of the program’s overall curriculum.
Competency-based medical education evaluation resources
General resources
- PD Toolbox – See the EPA and Evaluations Folder (Association of Family
Medicine Residency Directors [AFMRD]; available to AFMRD members) - STFM Resource Library – Search “milestones” or “evaluations.” (STFM; available to STFM members)
Interpersonal communication
- Patient Centered Observation Form (University of Washington School of Medicine; free)
Interprofessional teamwork
- Teamwork Effectiveness Assessment Module (TEAM) (ACGME; free)
Observation
- Direct Observation of Clinical Care (DOCC) app (ACGME; free)
Wellness
- Mini-Z (Institute for Professional Worklife; free for educational purposes)
- National Academy of Medicine: Provides links to a number of validated
instruments for measuring work-related dimensions of well-being, including the Maslach Burnout Inventory
- Van Melle E, Frank JR, Holmboe ES, et al. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019;94(7):1002-1009.
- Pinilla S, Lenouvel E, Cantisani A, et al. Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review. BMC Med Educ. 2021;21(1):172.
- Edgar L, McLean S, Hogan SO, et al. The Milestones guidebook. Accreditation Council for Graduate Medical Education; 2020. Accessed March 13, 2023.
- Accreditation Council for Graduate Medical Education. Milestones 2.0. Completed specialties and subspecialties and effective dates. Revised July 1, 2022. Accessed March 13, 2023.
- Newton W, Cagno CK, Hoekzema GS, et al. Core outcomes of residency training 2022 (provisional). Ann Fam Med. 2023;21(2):191-194.
- Newton WP, Magill M, Barr W, et al. Implementing competency based ABFM board eligibility. J Am Board Fam Med. 2023;36(4):703-707.
- Wheat S, Cole S. Individualized learning plans: who, what, when, where, why, and how?. Ann Fam Med. 2023;21(6):560-562.
- Accreditation Council for Graduate Medical Education. Executive summary. Individual learning plans. 2020. Accessed February 16, 2024.
- Newton WP, Rode K. What assessments are being used in family medicine
residencies? J Am Board Fam Med. 2024;37(1):155-159. - Anderson P. Physicians experience highest suicide rate of any profession. Medscape Medical News. May 7, 2018. Accessed January 11, 2023.
- O'Neill TR, Li Z, Peabody MR, et al. The predictive validity of the ABFM's In-Training Examination. Fam Med. 2015;47(5):349-356.