ACGME Core Competencies

Examples of Resident Difficulties & LORs

“LORs can provide useful clues to differentiate between students who are likely to become the least versus the most successful residency program graduates. Greater usage of the ACGME core competencies within LORs may be beneficial.”

J Grad Med Educ. 2011 Sep; 3(3): 387–390. doi:  10.4300/JGME-D-11-00010.1

In order for a Medical Doctor (MD) to become a U.S. licensed practitioner and sit for the American Board of Medical Specialties, s/he must have graduated from one of 9600+ residency program that is accredited by Accreditation Council for Graduate Medical Education (ACGME). In 2002, the ACGME launched a competency initiative called the Outcomes Project, resulting in the identification of six ACGME Core Competencies to be used by residency programs to evaluate the performance of their medical residents.

According to the ACGME 2014-2015 Data Source Book (page 65), 246 residents were dismissed, 18 unsuccessfully completed program, 883 withdrew and 1072 transferred to another residency program, causing significant disruptions year over year. Additionally, many of the 1000+ annually dismissed & withdrawn residents may never get the opportunity to re-enter our residency workforce, worsening our prospects of addressing the U.S. physician shortage crisis. Many program directors suggest that these numbers could be significantly reduced with better ACGME core competency training and addressing signs of future resident troubles in the pre-residency years, i.e. during clinical rotations. As a result, AmeriClerkships supervising attending physicians are encouraged to prepare and evaluate the student physician utilizing the six ACGME Core Competencies, and remain vigilant in addressing any signs of ‘Examples of Resident Trouble’ during any clinical encounters with such residency candidates.
AmeriClerkships also encourages all of its members to study these 6 core competencies, and incorporate them into their everyday clinical activities by working on a different core competency each day. To study each, visit the following in the New England Journal of Medicine’s Knowledge+ page:

Furthermore, ACMedical encourages that letter of recommendation (LOR) writers discuss how a residency candidate has met each of the 6 ACGME core competency utilizing objective evidence and unique patient interactions:

  • Click here to read A Physician Guideline for Writing Effective LORs
  • Click here for ACGME Core Competency based LOR Drafting Service by AmeriClerkships physicians to aid your supervising attending physician

In summary, our goal is to avoid as many of the ‘14 Markers of a Problematic Residency Application‘ (click the article below) prior to the certification and submission of a residency or fellowship application to training programs.