Graduate Medical Education Replacing the Apprentice-based Model Dr. Diane Hartmann Dr. David C. Leach, director of the Accreditation Council for Graduate Medical Education, praised us for being at the forefront of this movement. "The University of Rochester has become known as a medical school whose graduates have mastered the art of medicine. The deep interpretation of the competencies demonstrated by Rochester is no surprise; the school's traditions nourish them. I expect others to follow the patterns set in Rochester." A new model for graduate medical education has emerged in the last decade, and the University of Rochester has been leading that revolution. For decades, the grueling trial of residency enabled doctors to develop from the newly graduated to the certified and from the rawness of inexperience to the steadiness of the tested. Residents endured 120-hour work weeks and learned by apprenticing with more experienced physicians. That system evolved in an era when health care was delivered by individual physicians. Today, most care is delivered by teams of professionals in complex healthcare systems. Our educational model has adapted to reflect that reality. Core Competencies The University of Rochester's graduate medical education program is based on six core competencies as described by the ACGME: Patient Care—Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Medical Knowledge—Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of that knowledge to patient care. 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. Interpersonal and Communication Skills—Residents must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates. Professionalism—Resident must clearly show a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. System-based Practice—Residents must demonstrate an awareness of an responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. 360-degree Evaluation Attending physicians are not the only ones conducting assessments of a resident's performance. The 360-degree evaluation has become a popular tool, bringing fellow residents, nurses, secretaries, and patients into the critiquing process. "Peers can tell you how well you manage a team," says Dr. Diane Hartmann, the School's Associate Dean for graduate medical education. "The more junior people on a team know how organized you are, how well you teach, how well you interact with nurses and other residents, and how well you can engage a sense of camaraderie among your peers." Individualized Learning Plans Resident program directors are required to evaluate each resident's progress on a regular basis. Together, the resident and director review the evaluations received, faculty observations, performance on simulations, and Web-based courses. The residents also produce a self-reflection, describing what they think they have learned and where they want to focus their attention in the upcoming months.