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At the Intersection of Health, Health Care and Policy Cite this article as: Paul Batalden, David Leach, Susan Swing, Hubert Dreyfus and Stuart Dreyfus General Competencies And Accreditation In Graduate Medical Education Health Affairs, 21, no.5 (2002):103-111 doi: 10.1377/hlthaff.21.5.103

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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133.Copyright © 2002 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rightsreserved.

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Competenc y



General Competencies And Accreditation In Graduate Medical Education
An antidote to overspecification in the education of medical specialists.
by Paul Batalden, David Leach, Susan Swing, Hubert Dreyfus, and Stuart DreyfusPROLOGUE: Medical educators these days are bombarded with teaching requirements—genetics, ethics, communication skills, molecular medicine, geriatrics, sexual health, and computer literacy, to mention a few. These demands reflect the continued growth in scientific knowledge coupled with society’s expectation that physicians minister to social and psychological as well as physical infirmities. Timely andcohesive curriculum reform under these circumstances is a difficult proposition at the nation’s 145 medical and osteopathic schools and even greater at the more than 7,000 residency programs at some 1,500 hospitals throughout the country. Paul Batalden and colleagues describe the process undertaken by the accrediting authority for residency programs (the Accreditation Council for Graduate MedicalEducation, or ACGME) and the organization of certifying boards (the American Board of Medical Specialties). These two groups have agreed on six areas in which all physicians should be competent. The specification of these competencies is a milestone in itself in the complex world of graduate medical education. Embedding these concepts in training programs, however, will take a number of years, aprocess the authors map out for us. Batalden is the director of Health Care Improvement Leadership at the Center for the Evaluative Clinical Sciences, a professor of pediatrics and community and family medicine at Dartmouth Medical School, and the founding chair of the board of the Institute for Healthcare Improvement. Since 1997 David Leach has served as executive director of the ACGME, leading theorganization in its effort to engage a series of difficult issues including competency evaluation and residents’ work hours. Susan Swing, an educational psychologist, is director of research at the ACGME. Hubert Dreyfus is a professor of philosophy at the University of California, Berkeley, Graduate School; Stuart Dreyfus is a professor emeritus in that university’s Department of IndustrialEngineering and Operations Research. Hubert and Stuart Dreyfus’s 1986 book Mind over Machine contributed a developmental perspective to these core competencies.

H E A L T H A F F A I R S ~ Vo l u m e 2 1 , N u m b e r 5
©2002 Project HOPE–The People-to-People Health Foundation, Inc.


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