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Perspective: The ACGME Toolbox: Half Empty or Half Full?

Green, Michael L. MD, MSc; Holmboe, Eric MD


In the May 2010 article by Green and Holmboe,1 the information in the disclosures section was not complete. The complete information is stated below.

Michael L. Green, MD, is currently professor of medicine at Yale University. He serves on the Milestones Project working and writing group co-sponsored by the American Board of Internal Medicine (ABIM) and the Accreditation Council for Graduate Medical Education (ACGME) and was a Kimball Scholar at the ABIM Foundation from 2006 to 2007.

Eric Holmboe, MD, is currently the chief medical officer at the ABIM. The ABIM is one of the three appointing organizations to the Internal Medicine Residency Review Committee. Dr. Holmboe served as the ABIM's ex officio member between 2004 and 2008. Dr. Holmboe also served on the Milestones Project working group and is a current member of the ACGME Assessment Working Group. He is a member of the National Board of Medical Examiners. He receives royalties from Mosby-Elsevier for a textbook on assessment of clinical competence.

Academic Medicine. 86(1):84, January 2011.

doi: 10.1097/ACM.0b013e3181d737a6
Physician Competencies

The Accreditation Council for Graduate Medical Education Outcome Project changed the currency of accreditation from process and structure to outcomes. Residency program directors must document their residents' competence in six general dimensions of practice. A recent systematic review, published in the March 2009 issue of Academic Medicine, concluded that the instruments currently available are psychometrically inadequate for evaluating residents in five of the six competencies.

In this perspective, the authors refute the findings of this earlier review. They demonstrate that the review's search strategy was limited, failing to capture many important evaluation studies. They also question the appropriateness of the analysis of the included articles, which focused, to the exclusion of other important properties, on an instrument's ability to discriminate among residents' performance in the six competencies.

Finally, the authors argue that the problem is not the lack of adequate evaluation instruments but, rather, the inconsistent use and interpretation of such instruments by unskilled faculty. They urge the graduate medical education community—if it is to realize the promise of competency-based education—to invest in training for faculty evaluators rather than waiting for new instruments.

Dr. Green is associate residency program director and associate professor, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

Dr. Holmboe is senior vice president for quality research and academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania, and adjunct professor, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

Correspondence should be addressed to Dr. Green, Yale Primary Care Residency Program, Waterbury Hospital, 64 Robbins Street, Waterbury, CT, 06721; telephone: (203) 573-6574; fax: (203) 573-6707; e-mail:

© 2010 Association of American Medical Colleges