Lifelong Learning Competencies: Putting the ‘Purpose’ in Purposeful Education
One of ACC’s primary missions is to provide means and opportunities for cardiovascular professionals to continually refine their clinical performance and keep abreast of the latest developments in the field. This hasn’t been an easy task given the substantial and seemingly constant changes in the health care landscape, including rapid expansion and use of digital and mobile technologies, major modifications to maintenance of certification (MOC) requirements, and the transition away from a fee-for-service system to one that is focused on quality of care and outcomes. However, the College has risen to the challenge and over the last several years made unprecedented progress in developing a solid, competency-based learning framework that allows for learning that begins at the earliest stage of the cardiovascular career and continues through the years of clinical practice. The lifelong learning competencies now serve as the underpinning of all ACC education activities and a mechanism for development of needs assessment and personalized or focused education.
One of the biggest achievements was the release last March of the latest iteration of the Core Cardiovascular Training Statement – COCATS4 – which updated the training recommendations for cardiovascular fellows and defined, for the first time, the full array of competencies expected of clinical cardiologists upon completion of fellowship training. Over the past two decades, COCATS has served as an important vehicle for helping to take cardiology training into the new world order, but COCATS4 goes even further and has been called revolutionary by some.
Specifically, COCATS4 marked a transition away from training focused solely on standard medical knowledge and clinical skills, to training based on defined outcomes under the six domains developed by the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties (ABMS), and endorsed by the American Board of Internal Medicine (ABIM). These domains include interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.
Additionally, COCATS4 included new task force reports for critical care cardiology and multi-modality imaging, and emphasized cardiovascular disease prevention and ambulatory, consultative and longitudinal care, as well as inter-professional and team-based care. It also highlighted the importance of care coordination, chronic disease management, appropriate resource utilization and the needs of special populations.
While the COCATS4 recommendations are aimed at training program directors, faculty and trainees in cardiovascular fellowship programs, the College has been busy aligning these competencies with lifelong learning for practicing cardiologists. The goal: the transformation of cardiology into a set of competency-based experiences. Once a clinician has acquired the knowledge, mastered the skills, and developed the judgment necessary at the early stage of a career, a commitment to lifelong learning enhances the value of longitudinal experiences to enhance and maintain competency within the scope of practice.
With the release of the “2016 ACC Lifelong Learning Competencies for General Cardiologists” in February, the College has defined the skills that practicing cardiologists can reasonably be expected to maintain and enhance throughout the span of their careers. What makes this document truly unique is that it attempts to define those competencies that every cardiologist should maintain no matter what their career focus, while identifying those skills or activities that reflect a more specific practice focus.
In addition to identifying the required medical knowledge, patient care and procedural skills, the lifelong learning competencies address additional professional behavior competencies relevant to all clinical areas, as well as leadership and administrative competencies. As cardiovascular professionals are increasingly expected to serve as effective leaders of groups of practitioners, hospitals, health systems, professional societies like the ACC, and other organizations – the document delineates ways that cardiologists can maintain, enhance and assess leadership and/or administrative competencies.
What’s next? The ACC is developing Advanced Training Statements similar to the one for clinical cardiac electrophysiology, released this past September with the American Heart Association and the Heart Rhythm Society. These statements complement COCATS4 by defining the additional requisite skills necessary to practice in a narrowly-defined field for which advanced certification exists. They also describe key experiences and outcomes necessary to maintain or expand competencies in these fields during practice. Advanced training in these fields is also based upon the six core competency domains, and curricular milestones for each competency provide a “developmental roadmap” for fellows as they progress through training.
Future advanced training statements will focus initially on those subspecialties recognized by ABIM and ABMS, including advanced heart failure, interventional cardiology and adult congenital heart disease, but similar statements applicable to other fields may evolve in the future. These training statements will be followed by specialized lifelong learning statements of competencies that allow for continued growth over the course of a career. Working with specialty organizations and other cardiovascular care team members will be key to ensuring that appropriate evaluation tools are developed for these focused specialists.
Patients, physicians in other fields, the public and regulatory agencies should be confident that all cardiologists, no matter where they are in the course of their careers or what their field of practice, have the requisite competencies to fulfill the duties expected of them. Competent, well-rounded clinicians are critical to achieving the College’s mission of expanding the scope of cardiovascular care and improving heart health, and we are well along the path to this goal.
Eric S. Williams, MD, MACC and Jonathan L. Halperin, MD, FACC serve as chair and co-chair, respectively, of the ACC Competency Management Committee.
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