The ACGME Core Competencies

Six Core Competencies

These core competencies are crucial to post-undergraduate medical education. According to the ACGME website, they evaluate your readiness as a physician to provide high-quality, safe, effective, and patient-centered care within the ever-evolving healthcare landscape.

More than that, you need to know the six core competencies going into residency or fellowship interviews. Program directors are looking for applicants who already understand and align with the core competencies. To boost your chances, ensure your interview answers align with the competencies.

Below, you’ll find detailed definitions of each competency, plus examples of how to demonstrate these in a real-life setting.

Examples below are largely taken from the ACGME’s subcompetencies used to evaluate residents in a primary care specialty. Many of the examples apply outside of primary care, but it’s helpful for you to be aware of the source.

Patient Care

This competency involves providing compassionate, appropriate, and effective care to patients. This includes sticking to ethical principles while exemplifying good decision-making.

Examples of how you can demonstrate the Patient Care core competency include:

• Accessing patient chart information without help.
• Employing bedside manner while you’re placing an IV.
• Ordering the proper lab tests to determine the patient’s condition.
• Demonstrating knowledge of indications for various procedures.
• Identifying community resources to facilitate effective diagnosis of your patient who is from an underserved population.

Medical Knowledge

This competency is about demonstrating a strong understanding of established and evolving biomedical, epidemiological, social-behavioral, and clinical sciences.

Examples of how you can demonstrate the Medical Knowledge core competency include:

• Utilizing evidence-based medical skills to answer clinical questions, analyze the answers you discover, and apply the relevant aspects to patient care.
• Attending and participating in required conferences without missing or skipping any.
• Seeking medical knowledge from faculty, attendings, literature, group conferences, and electronic sources in order to better inform your care of the patient.
• Interpreting evidence-based medical statistics as they apply to specific clinical situations.

Practice-Based Learning and Improvement

Sometimes abbreviated to PBLI, this competency concerns self-awareness and self-assessment. ACGME wants to ensure you can investigate, evaluate, and improve your patient care practices by learning from mistakes and keeping up with modern literature.

Examples of how you can demonstrate the Practice-based Learning and Improvement core competency include:

• Developing and maintaining a willingness to learn from your errors.
• Identifying and utilizing the most effective web-based search engines to browse medical literature (PubMed, Ovid, Clinical Key, Google Scholar).
• Setting your own professional development, learning plan, and quality improvement goals.
• Locating, appraising, and assimilating evidence from scientific studies related to your patients’ health problems.
• Acting as a role model to MD or DO learners.

Interpersonal and Communication Skills

This competency emphasizes the importance of effectively communicating and collaborating with patients, families, and other healthcare professionals.

Examples of how you can demonstrate the Interpersonal and Communication Skills core competency include:

• Delivering bad news to a patient’s family with grace and compassion.
• Working well as a member or leader of a healthcare team, including learning your teammates’ names.
• Identifying who among the patient’s family is the primary provider of information.
• Maintaining comprehensive, timely, and legible medical records, if applicable.
• Using correct English in your written and verbal communications.

Professionalism

With this competency, you need to demonstrate a commitment to exemplifying medical ethics and holding true to your professional responsibilities.

Examples of how you can demonstrate the Professionalism core competency include:

• Interacting with patients, peers, faculty, and other health professionals in a respectful manner — including appropriate dress, verbal behavior, and non-verbal behavior.
• Demonstrating respect for patient privacy and autonomy.
• Recognizing important community roles that physicians fill, for example, a school board member or a community volunteer.
• Showing sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
• Recognizing ethical dilemmas and appropriately consulting a hospital’s ethics committee.

Systems-Based Practice

This competency requires you to be aware and responsive to the broader healthcare system and to utilize its resources to provide optimal care.

Examples of how you can demonstrate the Systems-based Practice core competency include:

• Considering cost-benefit analysis in clinical care while demonstrating commitment to cost-effective medical care.
• Recognizing resource limitations within a healthcare system.
• Differentiating between different medical practices, such as hospital vs. community models.
• Acknowledging potential conflicts of interest between patients and healthcare systems.
• Participating in system error identification and solution implementation.

How They’re Assessed

The six core competencies are assessed twice a year while you’re a resident or fellow. You may be evaluated on these competencies after graduation to maintain licensure. However, you may also be assessed in your residency application and interview either formally or informally.

If you fall short during residency assessments, faculty may organize a personalized learning intervention to realign your understanding of competencies or subcompetencies.

In Residencies and Fellowships

ACGME core competencies are assessed via direct observation, 360-degree evaluations, and performance-based assessments. These assessment tools are part of ACGME’s specialty-specific Milestones project, submitted twice yearly for each resident or fellow.

• Direct observation: Faculty members, attending physicians, program directors, and your program’s Clinical Competency Committee (CCC) may observe you during clinical activities, direct patient care, and collaboration with other healthcare workers.
• 360-degree evaluations: You’ll receive feedback from a diverse and comprehensive group of multiple raters, including faculty, peers, and other healthcare professionals.
• Performance-based assessment: You will be evaluated through specific skills and knowledge tests. These tests may include case presentations, written tests, cognitive assessments, and standardized examinations in some specialties.

To enter residency, you must show through the competencies that you can be entrusted with certain activities without supervision. These Entrustable Professional Activities (EPAs) may include common procedures, managing a patient overnight, and communicating bad news to patients or families.

In Interviews for Residency Programs

In residency and fellowship interviews, you will be assessed on your knowledge of the six core competencies. The assessment may be subtle or overt.

Interviewers may not mention that they want you to demonstrate the core competencies naturally in your answers to certain questions. However, you need to demonstrate the competencies in your responses.

For example, when they ask you, “Why do you want to be part of this residency in particular?” you can talk about the program’s dedication to the highest-quality patient care, innovative systems-based learning, or reputation for the most thorough medical knowledge training.

Of course, be honest, but look for ways to be honest that relate to the core competencies.

After Finishing Residency or Fellowship

When maintaining your medical license, you may be evaluated on your grasp of the six core competencies. For instance, the American Board of Medical Specialties (ABMS) uses the ACGME competencies as a framework for licensure maintenance in certain specialties, such as pediatrics.

Beyond licensure, the core competencies are meant to equip you for lifelong learning, faculty development, and practicing safe, effective medicine. So don’t just forget about them — they exist to make you the best doctor you can be.

The Importance Beyond Residency

The ACGME core competencies are important after residency and fellowship for the following reasons:

• These competencies are designed to be remembered and used for the rest of your professional career, ensuring safe and effective patient care.
• These competencies promote continuing education and self-evaluation after residency and fellowship, never allowing your medical knowledge to go out of date.
• These competencies are meant to improve the quality of broader health systems.
• These competencies should encourage interprofessional education, communication between healthcare workers, and effective team-based patient care. 

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