Medicine in general, and psychiatry in particular, is spearheading a new approach to residency training emphasizing competence. All psychiatry residents should know about it: Not only will it affect residents directly starting in January, but also residents’ input into the process is much needed.

The process was initiated by the Accreditation Council for Graduate Medical Education (ACGME), the group that makes sure that residency training programs provide a good education to residents. Under the ACGME are 26 residency review committees (RRCs), one for each specialty, which evaluate programs and set training guidelines. In July 2000 APA’s Board of Trustees directed APA’s Council on Medical Education and Career Development to initiate a process to define, develop, and collect best educational practices to measure the residency core competencies, as stated in the RRC’s New Program Requirements. The Task Force on Core Competencies was appointed to facilitate this process. The task force will not itself write core competencies, but rather will use its good offices to bring efforts in the field together.

Why all this now? One reason is that health care delivery is changing quickly. Witness, for example, the shift in emphasis from inpatient to outpatient care in the last 10 years. There also has been a push from both managed care and the public for more documentation of physician competence; no longer can physicians rely on a privileged position of social trust and prestige. In addition, psychiatric leaders, including board examiners, were becoming increasingly concerned that not all training programs were producing residents with a solid range of competencies. They were especially worried about the lack of demonstrated competence in psychotherapy evidenced by some candidates on the oral board exams.

Due to these and other factors, leaders in all fields of medical education agreed that residency training needs to emphasize the achievement of basic competencies, not the number of months spent on an inpatient service or the number of procedures performed. Two obvious questions followed: What are the basic competencies for each medical specialty, and how can they be assessed?

So far, the various groups involved have fleshed out the following six broad areas in which competence was previously agreed upon by the ACGME, Association of American Medical Colleges, American Board of Medical Specialties, and the Council of Medical Specialty Societies: patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice. A training program’s responsibility to assess competence across these areas is the essential feature of the new RRC requirements.

But this is a work in progress. The kinds of competencies being discussed for psychiatry include clinical assessment; the ability to conduct a range of individual, group, and family therapies; and so on. The field is now searching for the methodology to assess such competencies, and suggestions have included Observed Structured Clinical Examinations, in which an actor presents with a clinical problem, and the trainee is evaluated on both content and style of the interview.

A few key points need to be emphasized:

• The overall goal is to streamline medical education, from medical school through residency through certification and recertification, so that doctors in training and beyond are getting regular evaluation and feedback to ensure they are developing appropriately as clinicians.

• Ultimately, it is both training programs and individuals that are being assessed. For example, when training programs emphasize meeting service needs at the expense of education, the results should become apparent.

• This is a long-term project whose details are far from established. A great deal of work lies ahead to ensure fair and reliable methodology.

• I urge you to find out more by going to the ACGME Web site at <www.acgme.org> and clicking on "Residency Review Committee."

Most important, residents should get involved. The resident leaders of APA are in contact with the Psychiatry RRC to express resident concerns and ideas. In addition, Mara Goldstein, M.D., of New York University is representing residents on a four-person subcommittee. All residents should feel free to ask for information from their APA resident leaders, as well as their training directors. You can also check the APA Web site at <www.psych.org> or join APA’s education list serve (contact Nancy Delanoche at ndelanoche@psych.org) to discuss this and ask questions.