Assessing the ACGME Competencies in Psychiatry Training programs.

In 2000, the Accreditation Council of Graduate Medical Education (ACGME) laid out a definition of competence that included six specific areas of focus: patient care (including clinical reasoning), medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The ACGME's intention was to mandate increasingly reliable and valid assessment measures to be used by all training programs over the next decade, with the goal of providing "more credible, accurate, reliable and useful educational outcome data." In this article, the authors will review definitions of competency according to the new ACGME standards and examine the assessment tools currently available, including global evaluations, 360-degree evaluations, checklists, standardized examinations and direct observations. The authors will provide an overview of critical considerations in different assessment methods, including timing, psychometric properties, benchmarks, and feedback. Finally, the authors will discuss the relevant literature concerning the strengths and weaknesses of these various assessment tools. Throughout, the authors will comment on the applicability of the literature on assessment to the field of psychiatry and consider directions for competency assessment within and beyond psychiatric training. Following the paper is an annotated bibliography of the literature for those wishing to explore this topic more deeply and a list of web-based resources that may be used by those wishing to access available instruments.

Children facing the death of a parent: the experiences of a parent guidance program at the massachusetts general hospital cancer center.

Children facing the death of a parent are facing a major upheaval, a loss that will bring them emotional pain and will resonate in different ways at important points throughout their lives. Given the proper supports, most children can expect to adjust well to this enormous change and live happy,productive, and meaningful lives. Although some risk factors for poor adjustment are fixed, the parents themselves often can address others effectively. Clinicians can help the parents of these children facilitate their children's best possible adjustment by emphasizing the principles of facilitating communication, minimizing disruption, preserving family time, and at-tending to their legacy. Clinicians place their children's behaviors within the context of their developmental stage and help the parents find language and an approach that feels comfortable to them. The goal is to help parents re-locate their bearings and realize they can use the parenting skills they al-ready have. Guided by the goal of protecting their children, these parents can find purpose and strength. Reframing their circumstances as a painful and unavoidable challenge, but one that they can actively face, is organizing and fortifying for these families buffeted by loss.