University of Cincinnati Uses Achieving Competence Today (ACT) Program to Change Its Curriculum

Achieving Competence Today (ACT)

Field of Work: Quality of care.

Problem Synopsis: In 2000, the Institute of Medicine published a high-profile critique of the quality of patient care in this country, Crossing the Quality Chasm. In response, the Accreditation Council for Graduate Medical Education (ACGME) mandated that post-medical school physician training programs prove that their residents are competent in six areas of practice: patient care; medical knowledge; practice-based learning and improvement; interpersonal and communications skills; professionalism; and systems-based practice.

Synopsis of the Work: A Robert Wood Johnson Foundation national program, Partnerships for Quality Education, developed a four-week curriculum called Achieving Competence Today (ACT) aimed at teaching medical residents and nursing students two of the six competencies—practice-based learning, and systems-based and quality improvement-based practice. By 2006, some 25 teaching institutions had adopted the ACT curriculum. From 2006 to 2009, RWJF expanded ACT into a program of its own: Achieving Competency Today. Six teaching hospitals participated, including the University of Cincinnati College of Medicine.

Key Results: The University of Cincinnati Internal Medicine program was one of the earliest adopters of the Achieving Competence Today (ACT) curriculum. Under the ACT program, it changed the original four-week curriculum to a year-long elective, called Advanced Healthcare Improvement, for residents who had already undergone basic training in quality improvement. UC required that residents in internal medicine spend much more time in an ambulatory clinic—three and half days per week compared with about a half a day per week in the past. Participating residents identified quality improvement projects to undertake that were rooted in problems they saw in their everyday practice in the ambulatory clinic.

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