Mentoring , Education , and Training Corner

© 2013 by the AGA Institute 0016-5085/$36.00 http://dx.doi. org/10.1053/j.gastro. 2013.09. 029 Next Accreditation System (NAS) in July 2013, allopathic graduate medical education training programs accredited by the ACGME must use competency-based training to demonstrate that trainees have attained the knowledge, skills, and attitudes required for the practice of safe and effective unsupervised practice. Although new to many subspecialty program directors and faculty, CBME is not necessarily a new concept. The ACGME began the transition to CBME with the initiation of the Outcomes Project in 1997. Although the Outcomes Project proved helpful at introducing important terms and concepts, programs struggledwith implementing competency-based assessment and evaluation of trainees using this framework. Recognizing this barrier, the ACGME called for the development and eventual implementation of specialtyspecific developmental milestones to describe the progression of competence in the 6 general competencies (Figure 1). With the launch of the NAS in 2013, milestones reporting was formalized as 1 of 9 key performance indicators that will be used by the ACGME to determine a programs accreditation status. In early 2013, the Internal Medicine community completed the work of writing these milestones. The Internal Medicine subspecialties are now charged with developing similar milestones by early 2014. This article reviews important concepts relating to CBME and the development of milestones for Internal Medicine and its associated subspecialties. Defining CBME To effectively assess and evaluate trainees using milestones, subspecialty training program directors and faculty must first understand a number of basic definitions and principles of CBME. Described by Caverzagie as “competenglish,” negotiating this new lexicon requires defining CBME and an understanding of the key terms of competency, competent, and competence. CBME is defined as “an outcomes-based approach to the design, implementation, assessment and evaluation of a medical education program using an organizing framework of competencies. ” For ACGME-accredited programs, like those in gastroenterology and transplant hepatology, this organizing framework is the 6 general competencies listed in Figure 1. The outcome is a physician workforce capable of delivering safe, effective, unsupervised medical care that meets the needs of our complex and evolving health care system. The Institute for Healthcare Improvement Triple Aim Initiative and the Institute of Medicine definition of high-quality care provide examples of this outcome. Competency is defined as “an observable ability of a health professional, integrating multiple components such as knowledge, skills, values and attitudes. ” Not to be confused with the ACGME general competencies, which are the broad and overarching organizing framework of the NAS, this definition focuses on the specific abilities expected of the individual physician. For gastroenterology, completing a colonoscopy is an example of such a competency. To be judged competent requires that the trainee possess all the required abilities being assessed in a certain context at a defined stage of education or practice. In the current example, a fellow in the second year of training may be deemed competent to independently perform a routine or straightforward colonoscopy by having been observed successfully completing this procedure multiple times. However, this designation of competent performance is limited to straightforward colonoscopy and cannot be extended to include a more complicated colonoscopy that requires complex manual skills, such as a high-risk biopsy. Such a designation would require that