In search of coherence: a view from the Accreditation Council for Graduate Medical Education.

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly involved with CME. This article offers a perspective about the Conjoint Committee's recommendations from the executive director of the ACGME. It is a personal rather than an organizational perspective. Each of the 7 recommendations of the Conjoint Committee offers some opportunity for the ACGME and identifies issues that confront medical educators and accreditors at earlier stages of the formation of physicians. The Conjoint Committee's report also exposes the painful reality that organized medicine is almost hopelessly fragmented at a time when it is important to work together. Earlier efforts to produce a more coherent system of professional oversight have failed, but several emerging realities now may make possible what was not before. These include a common language for the competencies needed to practice medicine, common metrics of competence, technologic advances in learning portfolios, conceptual advances about the use of data on physician competence, and an inexorable focus on improvement of patient care. The possibility of patient-centered rather than profession-centered oversight is emerging. The most profound consequence of the Conjoint Committee's work may be a new organizational model, based on readily available data, that enhances trust. If so, a radical transformation of the accreditation of medical education will follow.