Competencies in Residency Training: Internal Medicine

Revised: September 1, 2016

The ACGME and ABMS have adopted six general competencies for resident training. The AOA (Osteopathic Residents only) has adopted these competencies as well, and added a seventh competency for Osteopathic Internal Medicine Residency Training. The Internal Medicine community collaborated to define the competencies as they apply to our specialty. Representatives from several leading internal medicine organizations contributed to this effort. The resulting standards are summarized below.

Competency #1: Patient Care

Residents must be able to provide patient centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

At the cornerstone of competent patient care are the abilities to:

  • gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records, and diagnostic/therapeutic procedures;
  • make informed recommendations about preventive, diagnostic, and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference;
  • develop, negotiate, and implement effective patient management plans and integration of patient care; and
  • competently perform the diagnostic and therapeutic procedures inherent to the practice of internal medicine.

Competency #2: Medical Knowledge

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care and the education of others.

Included in this context are:

  • an open-minded and analytical approach to acquiring new knowledge;
  • the ability to access and critically evaluate current medical information and scientific evidence;
  • acquisition of applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine; and
  • the application of this knowledge to clinical problem-solving, clinical decision-making and critical thinking.

Competency #3: Practice-Based Learning and Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

This effort encompasses the abilities to:

  • identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes, values, and processes of care;
  • analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient care;
  • use information technology and/or other avail­able methodologies to access, appraise, assimilate, and manage evidence from scientific studies, and incorporate evidence-based medicine into daily practice to optimize patient care, and enhance both patient and physician education; and,
  • Facilitate the learning of students and other healthcare professionals.

Competency #4: Interpersonal and Communication Skills

Residents must be able to demonstrate interpersonal skills that result in effective information exchange and teaming with patients, their patients’ families, and professional associates.

Included are the abilities to:

  • provide effective and professional consultation to other physicians and healthcare professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues;
  • use effective listening, nonverbal questioning, and narrative skills to communicate with, counsel, and educate patients and families;
  • interact with consultants in a respectful, appropriate manner; and
  • maintain comprehensive, timely, and legible medical records.

Competency #5: Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Included are the abilities to:

  • demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues;
  • demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors, and disabilities of patients and professional colleagues;
  • adhere to principles of confidentiality, scientific/academic integrity, and informed consent; and
  • recognize and identify deficiencies in peer performance.

Competency #6: Systems-Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value.

Included are the abilities to:

  • understand, access, and utilize the resources, providers, and systems necessary to provide optimal care;
  • understand how their patient care and other professional practices affect other healthcare professionals, healthcare organizations, and the larger society, and how these elements affect their practice.
  • Advocate for quality patient care and assist patients in dealing with system complexities;
  • Know how the types of medical practice and delivery systems differ from one another, including methods of controlling healthcare costs and allocating resources.
  • understand the limitations and opportunities inherent in various practice types and delivery systems and develop strategies to optimize care for the individual patient;
  • apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management, practicing cost-effective healthcare and resource allocation that does not compromise quality of care; and
  • collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and improve systematic processes of care.

Competency #7: Osteopathic Philosophy and Manipulative Medicine (For DOs only)

Residents must demonstrate and apply knowledge of accepted standards in Osteopathic Manipulative Treatment (OMT) appropriate to Internal Medicine. The educational goal is to train a skilled and competent osteopathic practitioner who remains dedicated to life-long learning and to practice habits in osteopathic philosophy and manipulative medicine.

Included are the abilities to:

Demonstrate competency in the understanding and application of OMT in Internal Medicine by way of the following:

  • Participate actively in OMT training opportunities both in the in-patient and out-patient settings.
  • Review major osteopathic journals on a regular basis.
  • Perform a critical appraisal of medical literature related to OMT.
  • Be observed and evaluated in the performance of OMT through the assessment of his / her diagnostic skills, medical knowledge, and problem solving abilities.

Integrate Osteopathic concepts and OMT into the medical care provided to patients as appropriate by way of the following:

  • Assume increased responsibility for the performance and incorporation of OMT in patient management.
  • Document OMT timely and comprehensively.
  • Promote OMT educational endeavors amongst peers and students.
  • Participate in CME programs provided by COMS, AOA and the specialty colleges.
  • Seek constructive feedback from osteopathic attending physicians.

Understand and integrate Osteopathic principles and philosophy into all clinical and  patient care activities by way of the following:

  • Utilize caring compassionate behavior with patients.
  • Demonstrate the treatment of people rather than the symptoms.
  • Demonstrate understanding of somato-visceral relationships and the role of the musculoskeletal system in disease.
  • Demonstrate listening skills in interaction with patients.
  • Demonstrate knowledge of and behavior in accordance with the osteopathic oath and AOA code of ethics.