American College of Physicians: Internal Medicine — Doctors for Adults ®

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Why the FCIM curriculum document—and why now

From the September 1996 ACP Observer, copyright 1996 by the American College of Physicians.

By Herbert S. Waxman, FACP

In the early 1990s, new special requirements for accreditation of residency programs mandated that all programs have a formal, written curriculum available for inspection by a site visitor during program reviews by internal medicine's Residency Review Committee (RRC). Program directors turned to the Association of Program Directors in Internal Medicine (APDIM) to see if a single curriculum document could be developed for the specialty so that each program didn't have to "re-invent the wheel." APDIM's leaders took the question of further curriculum development to the Federated Council for Internal Medicine (FCIM), hoping that its member organizations would be willing to respond to the need of program directors.

FCIM created a curriculum committee that consisted of one representative appointed by each FCIM member and several education consultants. The committee then named a working group to develop a first draft of a document that could begin to define a curriculum for residency training. From the beginning, the development process was dynamic, with opportunities for input by many educators.

The first draft included text describing the specialty of internal medicine, the changing environment, the educational process and the values and attributes of the caring, competent internist. A list of requisite competencies was formulated, and each was developed by a team that represented program directors and content experts. The draft also suggested which teaching venues might be best for the teaching of particular competencies. After completion of the first draft, there was a large stakeholders' conference from which many suggested revisions emanated.

At about the same time, in 1995, GME educators became concerned that the RRC might use the FCIM document to generate an onerous list of new special requirements for accreditation. Program directors and department chairs were already reeling from the impact of the hundreds of new special requirements imposed on them, some without evidence of their validity, and from the problems of a hastily introduced computer software program they were required to employ. Association of Professors in Medicine (APM) and APDIM officials said they would not vote for a FCIM-endorsed product until their fears about its use by the RRC had been allayed.

These forces converged at the spring 1996 FCIM meeting. For the leaders of the large internal medicine membership organizations—ACP and the American Society of Internal Medicine—the curriculum document provided a much-needed description of the competencies expected of a general internist and the educational process through which these competencies would be gained. On the other hand, the leaders of APDIM and APM said they would not consider giving their approval until the RRC issue was settled.

The RRC chair, who was present at the meeting, reported that the RRC planned a speedy review of the existing special requirements and current accreditation process. He anticipated that that review would be completed by this fall and that it would assuage the fears of the APM and APDIM. By the end of the spring meeting, it seemed likely that the fall FCIM meeting should be able to focus on resolving the remaining curriculum issues.

Meanwhile, since so many copies of the draft version have been circulated, the FCIM curriculum guide—even without formal FCIM endorsement—is already having a positive impact on residency training programs. It has been duplicated and disseminated and is allowing program directors to effect change in their individual departments and institutions.

Dr. Waxman is ACP's Senior Vice President for Education and was president of APDIM and chair of FCIM in 1993-94.

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