A method for defining competency-based promotion criteria for family medicine residents

The Accreditation Council for Graduate Medical Education (ACGME) has mandated a shift from a structure- and process-based educational system to a competency-based system. The ACGME has not provided criteria (standards), preferring to leave that to the discretion of the individual training programs. Such criteria and an overall strong evaluation process are essential for residents to attain the appropriate knowledge, skills, and attitudes. With this need in mind, the authors describe an evaluation process in which they developed ACGME-competency-based promotion criteria for family medicine residents at the University of Kentucky College of Medicine in 2004. The authors thought that by providing residents and faculty with minimum criteria that residents must demonstrate at each level, the residency program could address the ACGME mandate to provide competency-based training and improve residents' progress toward promotion. Along with the promotion criteria, the method of instruction and the setting for each criterion were identified. Tools were developed to assess the criteria, including a computer-based "same day preceptor evaluation", a resident portfolio, and multisource feedback instruments. This information was formatted into a matrix. Making the task and criteria clearer to learners allows them to better demonstrate what is expected of them. Residency educators can target remediation in those residents failing to meet the criteria and improve faculty skills, especially in terms of how to train for and assess competence. The authors describe the initial use of the promotion criteria, including how the faculty and residents responded to it.