ACGME | Accreditation Council for Graduate Medical Education

In 2005, under the leadership of then Executive Director and CEO, David C. Leach, MD, the ACGME contemplated the next steps in the evolution of competency-based education and assessment. One idea that surfaced was the development of an electronic, web-based learning portfolio. Not only a portfolio that supported resident learning, but one that also provided program directors with the ability to “connect the dots” between the variety of learning experiences that their programs offered and the developing competence in residents that resulted, based on multi-source feedback and data points captured within the portfolio.

The ACGME was in the unique position to develop such a tool that could be made available to all residents and programs. By taking a leadership role, the ACGME could hopefully avoid the pitfalls that had plagued the electronic medical record, the development of which was largely uncoordinated across the field. Offering a standard tool with the collection of consistent data points (to be determined by each specialty) would allow for national comparative analysis of current graduate medical education practices, and, ultimately, insight into ways in which to make improvement.

The following table briefly summarizes the steps taken to move the portfolio idea forward to a plan for development and execution.

September 2005	ACGME Board authorized initial exploration and development of a portfolio
Spring 2006	Competency-Based Portfolio Advisory Committee (CBPAC) convened to meet 3 times to develop recommendations for moving forward
February 2007	ACGME Board accepts final recommendations of CBPAC contained within their final report (see below)

In August 2007, testing of an early alpha prototype of the portfolio began with innovators from several academic medical centers that had been involved in the development process (along with ACGME leaders and selected staff). Early alpha testing focused on usability, functionality, and reliability of the portfolio. With early successes in each of these areas, additional programs from varied specialties were incrementally added to the alpha testing process, bringing the total number of active users close to twenty.

In June 2008, an ALP User Group was formed to facilitate sharing of ideas and to bring to bear a collective user voice in providing feedback to the ACGME about needed enhancements to the portfolio. Fine-tuning of the alpha software continued through the academic year based on this group’s feedback. As preparations for the release of a beta test version of the portfolio progresses (slated for fall 2009), the ACGME is working to build on the lessons learned from the alpha test phase – including the need to optimize the ease of set-up and initialization of the portfolio, as well as the functionality of key modules, such as learning activities and evaluations.

Once the beta test version has been thoroughly vetted by currently enrolled sites and system modifications made, a ‘rollout’ beta version of the portfolio will be made available to current and new beta enrollees (those that were accepted as part of a previous application process, along with newly interested programs) in early 2010.

In the May 2008 (PDF) and the September 2008 (PDF) publications of the ACGME Bulletin, Thomas J. Nasca, MD, CEO of the ACGME, articulates his vision for the future of GME and the continued advancement of the ACGME’s Outcomes-Based Accreditation Project. An integral part of the vision is the creation of milestones of resident competency development. The milestones will define the behavioral attributes that are essential to be demonstrated in each competency domain before a resident graduates and at other key points during the resident’s education.

Specialty milestone groups are being convened to develop milestones and identify assessment tools. The milestones, assessment tools, and common curriculum components will be pre-loaded into specialty-specific versions of the portfolio. ALP will serve as the required repository for semi-annual documentation of resident performance against the milestones. ALP will also aggregate the data and produce local and national reports. Such data will support program review and improvement.