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On Competence

December 11, 2021
by Mark David Siegel

Hi everyone,

Twice yearly, I’m asked to assess your clinical competence. The ACGME requires it, society demands it, and it’s my duty to confirm it.

Last week, in two marathon meetings, the Clinical Competency Committee discussed the performance of each of our residents, 148 in total. Dr. Paul Bernstein chairs the committee, which includes program leadership, additional faculty, and the Chiefs, who technically attend as “guests.” In the fall, we ask if you’re progressing as expected, and in the spring, we ask if you’re ready for promotion or graduation. For most of you, the question is easy: you’re either on or ahead of schedule. We know this from your MedHub evaluations, ITE scores, and reports from clinic preceptors and inpatient faculty.

We have standard expectations for each residency class, which we assess by monitoring your performance in the ACGME’s six core competencies: Medical Knowledge, Patient Care, Practice-Based Learning and Improvement, Systems-Based Practice, Interpersonal and Communication Skills, and Professionalism (see attached). By this time of the year, all interns should have mastered core clinical skills, all PGY2s should be effectively leading teams, and all PGY3s should be showing readiness to practice independently.

Many of you are progressing ahead of schedule. Evidence includes your ITE scores, commitment to your patients, contributions to the residency, achievements in quality improvement, and communication with colleagues and staff. We recognize extraordinary performance by “marking you up” (i.e., moving you to the right on your milestone report).

Occasionally, we move people to the left, for example when ITE scores are very low, when residents don’t respond to emails from program leadership or complete MedHub tasks, or when residents fail to reliably check Epic in-boxes or follow up promptly on outpatient test results. We consider these evaluations formative, meaning they’re an opportunity to show residents where they need to improve. Thankfully these concerns are rare, and the APDs will follow up shortly with residents who are behind schedule. In general, these concerns should not surprise anyone, and we expect all concerns to be addressed effectively before the CCC meets again in the spring.

CCC meetings are exhausting but exhilarating. They remind us how skilled, responsible, and compassionate you are. I look forward to submitting these reports to the ACGME. The truth is you’re beyond competent- you inspire us, and we’re beyond proud.

Enjoy your sunny Sunday, everyone,


PS: COVID rates are rising again and we’re seeing many breakthrough infections. Vaccines should protect you from serious illness, but we don’t want anyone to become ill. Please wear masks whenever you’re indoors with non-family members, preferably N95s or equivalents, and consider celebrating the holidays outdoors or at least with open windows to promote ventilation. Please protect yourselves and everyone around you.

PPS A recent COVID reading list:


Submitted by Mark David Siegel on December 12, 2021