From the Editor: The "Tipping Point" in the ACGME Competencies in Ophthalmology
2008, Volume 1, Number 2 60 The Accreditation Council for Graduate Medical Edu-cation (ACGME) is now several years into the na-tional grand experiment of integrating six general competencies into residency training across special-ties in the United States. For those of us in the trenches of graduate medical education, the process has been interesting and educational but it also has been frustrating, slow and not without its share of controversy. I believe that academic ophthalmology is now at a critical tipping point for the ACGME out-come project. As with any new initiative there have been exciting educational innovations created by small groups of daring explorers; there has also been grudging acceptance and even modest participation in the process by a cadre of early adopters (perhaps as high as 20%). Unfortunately, the vast majority of pro-grams ( the middle 60% ) are still waiting for their marching orders before they will commit to full im-plementation of the ACGME competencies and worse the last 20% of programs will likely only be brought along kicking and screaming . I believe that we are therefore at a critical balance point between failure and success in terms of the widespread adoption of the ACGME competencies. Success will likely require three top down events: 1) The ACGME must provide specific, measurable, realistic, time limited, and prescriptive approaches to meeting the competency requirements; 2) The spe-cialty residency review committees (RRCs) must en-force the mandate and begin to cite programs for non-compliance with the competency mandate; and 3) The specialty stakeholders (i.e., the Academy of Ophthal-mology), certifying (i.e., the boards), credentialing and licensing, accreditation, and the academic leader-ship organizations must come together to align their organizational objectives with the ACGME mandate and to recommend and approve specific assessment tools to their individual constituencies that will be acceptable to all in the short term (i.e., transition tools in testing or development) and in the long term (e.g., longitudinal benchmarks and outcome measures). The guiding principles for both designing and imple-menting the necessary tools to meet the requirements of the ACGME competency mandate have already been described for ophthalmology and by other au-thors in other specialties. I will summarize the key issues for moving forward below. Formative feedback that forms the basis of summative feedback. The goal I believe is to teach and assess at the same time and in the same encounter. Both formative (i.e., feedback that allows for learner improvement over time) and summative (i.e., the final grade) feedback mechanisms will need to be in place that provide ob-jective assessment of competence across all six of the ACGME competency domains. The formative com-ponent ideally would occur midway during the learner's rotation or learning experience and the sum-mative feedback would document both completion of the content and an accurate quantitative and qualita-tive assessment of performance at the end of the learning encounter. Ideally, the feedback process would be structured, scheduled, involve multiple (i.e., From the Editor: The Tipping Point in the ACGME Competencies in Ophthalmology Andrew G. Lee, MD 1* 1 Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA * Corresponding Author & e-mail: andrew-lee@uiowa.edu Accepted for publication May 20, 2008 2008; 1:60-61 Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. The views and opinions expressed in this editorial are strictly the personal views of the author and do not represent the opin-ions or positions of the ACGME, RRC, or any other organiza-tion. The contents of this editorial have not been reviewed or approved by any of the accrediting, certifying or credentialing bodies mentioned in this editorial. 2008