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Nov 3 2009

The ‘Six Core Competencies’: Evaluating licensee performance and conduct

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The North Carolina Medical Board has a duty to address misconduct and substandard care. However, its members also consider taking proactive steps to help prevent such problems to be a priority.

To that end, this issue of the Forum begins a series of short features on an important tool the Board uses to evaluate possible misconduct: the ACGME's six core competencies.

A decade ago, the Accreditation Council for Graduate Medical Education (ACGME) endorsed six core competencies it expects all medical residents to demonstrate proficiency in. Since then, the core competencies have gained acceptance among numerous healthcare organizations as a useful means of gauging clinical aptitude. For example, the American Board of Medical Specialties uses the six core competencies as part of its Maintenance of Certification programs. Just last year, the Joint Commission began requiring all accredited hospitals to capture physician-specific data that indicate proficiency in the six core competencies.

The Board has used the core competencies as a framework for discussing disciplinary cases for some time. It has observed that licensees under review usually exhibit shortcomings in one or more competency.

This February, during a Board retreat, Board members hit on the idea of educating licensees about the core competencies as a means of preventing problems. In general, the Board believes that a licensee who demonstrates proficiency in the core competencies can reduce his or her chances of patient complaints or disciplinary action.

Licensees who work with resident training programs or who are active members of an accredited hospital staff are likely at least generally familiar with the competencies. However, the Board recognizes that many licensees practice in settings that do not bring them in regular contact with the competencies and may be unfamiliar with them.

Over the next few issues of the Forum, the Board will highlight two competencies per issue in detail, and publish a complete list of all six competencies. Detailed definitions for each competency are taken from the ACGME.

In this issue: Patient Care and Medical Knowledge
Read the detailed definitions for information on what behaviors and skills demonstrate proficiency within a particular competency.

Patient Care: "What you do"
Practitioners must be able to provide patient care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health. Practitioners are expected to:
  • Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.

  • Gather essential and accurate information about their patients.

  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment.

  • Develop and carry out patient management plans.

  • Counsel and educate patients and their families.

  • Use information technology to support patient care decisions and patient education.

  • Perform competently all medical and invasive procedures considered essential for the area of practice.

  • Provide health care services aimed at preventing health problems or maintaining health.

  • Work with health care professionals, including those from other disciplines, to provide patient-focused care.

Medical Knowledge: "What you know"
Practitioners must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Practitioners are expected to:
  • Demonstrate an investigatory and analytic thinking approach to clinical situations.

  • Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.


A complete list of the six competencies appears below.
  • Patient Care

  • Medical Knowledge

  • Practice-based Learning and Improvement

  • Interpersonal and Communication Skills

  • Professionalism

  • Systems-based Practice

 Comments on this article:

timely and useful as we elevate patient-focus, quality and professionalism in practice
thank you.

By martin-j. sepulveda, md facp on Nov 10, 2009 at 10:16am

The core competencies also must serve as the basis for all CME activities under the most recent system of CME accreditation.  In addition, Part IV of maintenance of certification requires that physicains assess their own practices regarding a specific disease entity or process of care, which is the essence of performance improvement CME.  These two processes act as a mechanism for physicians to self assess vs. various aspects of the core competencies.  This in itself is a demonstration of competency in the area of “practice based learning and improvement.  CME providers in NC can assist phsycians in designing these activities and in receiving CME credit for their efforts.  In addition all CME activities should now be designed to improve physician competence, performance or patient outcomes.

By Harry A. Gallis MD on Nov 10, 2009 at 10:55am
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