A Plastic Surgeon s View of the ACGME Competencies

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Derick Sanders
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1 A Plastic Surgeon s View of the ACGME Competencies Robert A. Weber, MD Professor of Surgery Plastic Surgery Residency Director

2 Origin of the Competencies Institute of Medicine Report Patient Dissatisfaction Outcomes Based Education

3 The Six ACGME Competencies 1. Medical Knowledge 2. Patient Care 3. Practice-Based Learning and Improvement 4. Systems-Based Practice 5. Professionalism 6. Interpersonal and Communications Skills

4 Clinician-Focused Competencies 1. Medical Knowledge Do I have the fund of knowledge needed to practice plastic surgery? 2. Patient Care Can I apply my knowledge to a particular patient? 3. Practice-based Learning and Improvement Can I do what I tell my patients I can do, and can I analyze myself and the literature in a way to bring about self-improvement? 4. Interpersonal and Communications Skills Can I explain the proposed treatment options to the patient, family, and other health care associates in such a way that they will be able to help the patient achieve the optimal outcome? 5. Professionalism Will I practice ethically, putting the patient s needs above my own? 6. Systems-based Practice What resources are available to help the patient achieve optimal results, and what circumstances does the patient have to overcome?

5 An Example of Clinician-Focused Competencies 1. Medical Knowledge Do I have the fund of knowledge needed to practice plastic surgery? Using a patient with a tendon laceration as an example, medical knowledge is mastering the subjects of the inflammatory process, tendon and wound healing, hand anatomy, surgical techniques, anesthesia, microbiology of trauma, rehabilitation principles, just to name a few. 2. Patient Care Can I apply my knowledge to a particular patient? Following the tendon laceration example, patient care is the ability to assess the patient preoperatively, decide what particular tendon repair technique, medications, and rehabilitations protocol should be chosen for this particular patient from a variety of potential options, and manage complications. 3. Practice-based Learning and Improvement Can I do what I tell my patients I can do, and can I analyze myself and the literature in a way to bring about selfimprovement? Problem-based learning is the ability to study personal post-operative outcomes and decide whether a recently published novel tendon repair technique will improve results. 4. Interpersonal and Communications Skills Can I explain the proposed treatment options to the patient, family, and other health care associates in such a way that they will be able to help the patient achieve the optimal outcome? The surgeon needs to be able to ascertain whether or not the patient will be able to follow a detailed rehabilitation protocol, to communicate clearly with the therapists, and to have sufficient rapport with people to be able to help the patient through the discouraging times of recovery. 5. Professionalism Will I practice ethically, putting the patient s needs above my own? Professionalism is the imperative of a surgeon willing to be inconvenienced rather than delaying repair until it fits a schedule, handling complications with integrity and billing honestly, and overlooking the fact that the injury occurred while the patient was driving under the influence. 6. Systems-based Practice What resources are available to help the patient achieve optimal results, and what circumstances does the patient have to overcome? A systems-based approach to care recognizes that optimal results over time require cooperation from the emergency department, an efficiently running hand clinic, and skilled hand therapists, and can be hindered by job requirements, difficulty getting to therapy, and economic constraints.

6 Competency Based Case Presentation 1. Medical Knowledge What topics do I need to know to help this patient? 2. Patient Care How do I apply what I know to this particular patient? 3. Interpersonal and Communications Skills What do I need to explain to this patient, family, and other health care associates so that they will be able to help the patient achieve the optimal outcome? 4. Professionalism What ethical decisions does this patient raise? 5. Systems-based Practice What resources are available to help this patient achieve optimal results, and what circumstances does this patient have to overcome? 6. Practice-based Learning and Improvement What can I learn from this patient to help me with my next patient?

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