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AME FORMAT
Author: Eric Warm M.D.
Don’t worry about how the text looks – just send it to me and I will make it look pretty.
The AME format will be much the same as we are doing now. The basic format will be:
ACGME Core Competencies
Learning Objectives
Introduction
Content
Cases and Questions
Answers
References
On the following pages you will find a detailed description of each of these categories.
Please try stick to this basic format.
ACGME CORE COMPETENCIES:
List all of the ACGME core competencies that will be covered in your presentation. In case you forget
what they are, here are the core competencies (in your AME you only need to list them):
Patient Care
The first ACGME core competency area, "Patient Care", states that residents must be able to provide
patient care that is compassionate, appropriate, and effective for the treatment of health problems and the
promotion of health. According to the ACGME, residents are expected to:
1. Communicate effectively and demonstrate caring and respectful behaviors when interacting with
patients and their families.
2. Gather essential and accurate information about their patients.
3. Make informed decisions about diagnostic and therapeutic interventions based on patient
information and preferences, up-to-date scientific evidence, and clinical judgment.
4. Counsel and educate patients and their families.
5. Use information technology to support patient care decisions and patient education.
6. Competently perform all medical and invasive procedures considered essential for the area of
practice.
7. Provide health care services aimed at preventing health problems or maintaining health.
8. Work with health care professionals, including those from other disciplines, to provide patientfocused care.
Medical Knowledge
The second ACGME core competency area, "Medical Knowledge", states that residents must demonstrate
knowledge about established and evolving biomedical, clinical and cognate (epidemiological and socialbehavioral) sciences and the application of this knowledge to patient care. For this ACGME competency
area, residents are expected to:
1. Demonstrate an investigatory and analytic thinking approach to clinical situations.
2. Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.
Practice-Based Learning and Improvement
For the third ACGME core competency area, "Practice-Based Learning and Improvement", residents must
be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence,
and improve their patient care practices. In this area, residents are expected to:
1. Analyze practice experience and perform practice-based improvement activities using a systematic
methodology.
2. Locate, appraise and assimilate evidence from scientific studies related to their patient’s health
problems.
3. Obtain and use information about their own population of patients and the larger population from
which their patients are drawn.
4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other
information on diagnostic and therapeutic effectiveness.
5. Use information technology to manage information, access online medical information; and support
own education.
6. Facilitate the learning of students and other health care professionals.
Interpersonal and Communication Skills
In the fourth ACGME core competency area, "Interpersonal and Communication Skills", residents must
be able to demonstrate interpersonal and communication skills that result in effective information
exchange, and teaming with patients, their families and professional associates. To demonstrate
competency in this ACGME area, residents are expected to:
1. Create and sustain a therapeutic and ethically sound relationship with patients.
2. Use effective listening skills, and elicit and provide information using effective nonverbal,
explanatory questioning and writing skills.
3. Work effectively with others as a member or leader of a health care team or other professional group.
Professionalism
For the fifth ACGME core competency area, "Professionalism", residents must demonstrate a
commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population. The ACGME states that residents are expected to:
1. Demonstrate respect, compassion and integrity; a responsiveness to the needs of patients and society
that supercedes self-interest; accountability to patients, society and the profession; and a commitment
to excellence and ongoing professional development.
2. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical
care, confidentiality of patient information, informed consent and business practices.
3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities.
Systems-Based Practice
The sixth ACGME core competency area, "Systems-Based Practice", states that residents must
demonstrate an awareness of and responsiveness to the larger context and system of health care and the
ability to effectively call on system resources to provide care that is of optimal value. To demonstrate
competency in "Systems-Based Practice", the ACGME expects residents will be able to:
1. Understand how their patient care and other professional practices affect other health care
professionals, the health care organization and the larger society, and how these elements of the
system affect their own practice.
2. Know how types of medical practice and delivery systems differ from one another, including methods
of controlling health care costs and allocating resources.
3. Practice cost-effective health care and resource allocation that does not compromise quality of care.
4. Advocate for quality patient care and assist patients in dealing with system complexities.
5. Know how to partner with health care managers and health care providers to assess, coordinate and
improve health care, and know how these activities can affect system performance.
INTRODUCTION
This should be a brief statement of the importance of your topic, a ‘hook’ if you will, to get the
reader interested. This may be a good place to ask a question that you know the residents don’t
know the answer to.
LEARNING OBJECTIVES
A good learning objective is a brief, clear statement of what the student should be able to do as a result
of training. It should look at how the learning relates to successful completion of the task or job. Good
learning objectives:
1.
2.
3.
4.
Focus on student performance, not teacher performance.
Focus on product - not process.
Focus on terminal behavior - not subject matter.
Include only one general learning outcome in each objective.
Good learning objectives describe the behavior of the learner, and:



are stated clearly
define or describe an action
are measurable, in terms of time, space, amount, and/or frequency.
Recognize
Measurable Action Words (examples)
Prioritize
Analyze
Create
Discuss
Construct
Articulate
Describe
Apply
Assess
Evaluate
Identify
Develop
Define
List
Words to avoid are to “To know” or “To Understand”. These are passive, can be answered with a yes or a
no, and are difficult to measure: Do you know the causes of congestive heart failure?” asks the teacher.
“Yes,” says the student. Better: “ Identify three causes of CHF,” says the teacher. In answering, the
student demonstrates whether or not they really know something. Good learning objectives are short,
contain only one thought per line, and are specific.
For example:
BAD: After this presentation the student should recognize the causes of renal failure.
BETTER: After this presentation the student should recognize five causes of renal failure.
The latter objective is objective is specific and measurable. The first one is not.
More good examples:
After this presentation the student should be able to:
1.
2.
3.
4.
5.
6.
List five indicators that link a healthy community to healthy economy
Demonstrate the proper technique in breaking bad news
Define the terms withdrawal, tolerance and addiction
Create a differential diagnosis for chest pain
Describe the first 3 steps in evaluating the chest pain patient
Properly dose 3 types of steroids in COPD
If you find it difficult to do this send me what you have and I will help you.
CONTENT
This is where you research a topic and present what you want the learner to learn. Here are some
suggestions:
1. Keep it short – no more than 2 to 4 pages (12 font). If you can’t fit into 2 to 4 pages we’ll split it
up into two or more weeks
2. Keep it relevant – topics should be things a primary care physician is likely to encounter during
daily practice.
3. Keep it practical – make sure you have 3-5 take home points, and highlight what those points are.
4. Use a bottom line approach – provide a reference where the reader can go if he/she desires more
information.
5. If you need tables or graphs let me know what they are I will get them for you.
CASES AND QUESTIONS
When we go web based I envision a set of cases and questions to begin each module with. The learner
would have to answer the questions before getting to the module (if you want to see an example of what
this looks like see: www.hopkinsilc.org)
Preferred approach: write a realistic case or set of cases and ask several questions – some multiple
choice, others for discussion (See example at end of this section)
WHAT WILL MAKE THIS PROJECT SPECIAL IS THE QUALITY OF THESE CASES.
An Example of a case followed by questions:
A 59-year-old man with no past medical history comes to your office because he was found to have high
blood pressure on an insurance physical exam (he hands you the report -- BP right arm 170/100, left arm
168/100). He tells you an old doctor in the past said his blood pressure was a little high, but he didn’t
prescribe anything. He feels well and has no complaints (other than the fact that his insurance rates are
now much higher than before). He plays golf one time a week, using a cart most of the time. He does no
other exercise. He has been trying to lose weight. He takes no prescribed drugs. He smokes four cigarettes
a day (more on the weekends). He drinks a six-pack on Sundays. His brother had a heart attack at age 53.
BP right arm 180/104
BP left arm 176/102
Pulse 88
BMI 33
Normal Fundi
Neck: No bruits
Heart:II/VI SEM
Lungs: CTA
Abd: Obese, no bruit
Ext: no edema, 1+ pulses
1. The patient asks you if he has hypertension. Your best response:
A. Duh.
B. He has new classification stage 1 hypertension
C. He has new classification stage 2 hypertension
D. You don’t call it hypertension unless you’ve taken it yourself on two separate
occasions
2. The patient tells you that he hates doctors because of an unfortunate incident involving an ear
speculum when he was younger, and he gets nervous when he sees your white coat. He has a
friend who wore a BP monitor at home and asks you if he could get one. You tell him:
A. Studies have shown there is no such thing as white coat hypertension
B. Studies have shown that white coat hypertension is a greater risk factor than levels
measured by ambulatory blood pressure monitoring
C. Studies have shown that ambulatory blood pressure monitoring correlates better with
office measurement for end organ damage
D. If blood pressure goes up when you sleep and you have a dream about it, you will die
in your sleep
E. If blood pressure fails to decrease during sleep, there is an increase in cardiovascular
events
3. What initial studies should you order for your patient?
A.
B.
C.
D.
E.
F.
G.
H.
EKG
UA
Blood glucose
Hematocrit
Potassium
Creatinine
Calcium
Lipid profile
4. Your patient has normal labs except for a fasting LDL cholesterol of 188, HDL of 33, and
TG’s of 399, and glucose of 146. Given the entire scenario, how many major cardiac risk factors
does he have?
A.
B.
C.
D.
E.
2
4
6
8
10
5. Should you prescribe medications for your patient at this visit?
6. If so, what drug (s) will you prescribe
7. If you are going to give you patient medications, how important is it for him to follow a diet?
ANSWERS
Provide answers to your questions, and the reasoning behind each answer.
Example of answers to above case:
Answers:
1. Answer C. Stage 2. The classification system has been simplified in JNC VII
compared with JNC VI. D. is not correct because the patient has had at least two checks
in the past.
2. Answer C and E : Ambulatory blood pressure monitoring (ABPM)17 provides
information about BP during daily activities and sleep. ABPM is warranted for evaluation
of “white-coat” hypertension in the absence of target organ injury. It is also helpful
to assess patients with apparent drug resistance, hypotensive symptoms with
antihypertensive medications, episodic hypertension, and autonomic dysfunction.
The ambulatory BP values are usually lower than clinic readings. Awake, individuals
with hypertension have an average BP of more than 135/85 mmHg and
during sleep, more than 120/75 mmHg. The level of BP measurement by using
ABPM correlates better than office measurements with target organ injury.18
ABPM also provides a measure of the percentage of BP readings that are elevated,
the overall BP load, and the extent of BP reduction during sleep. In most
individuals, BP decreases by 10 to 20 percent during the night; those in whom
such reductions are not present are at increased risk for cardiovascular events.
3. All correct: Routine laboratory tests recommended before initiating therapy include an
electrocardiogram; urinalysis; blood glucose and hematocrit; serum potassium,
creatinine (or the corresponding estimated glomerular filtration rate [GFR]),
and calcium;20 and a lipid profile, after 9- to 12-hour fast that includes high density
lipoprotein cholesterol and low-density lipoprotein cholesterol, and
triglycerides. Optional tests include measurement of urinary albumin excretion
or albumin/creatinine ratio. More extensive testing for identifiable causes
is not indicated generally unless BP control is not achieved.
4. Answer is D, eight (HTN, smoking, obesity, inactivity, dyslipidemia, diabetes, age,
family history)
5. Yes
6. Best choices: ACE inhibitor, thiazide diuretic. Thiazide-type diuretics should be used
in drug treatment for most patients with uncomplicated hypertension, either alone or
combined with drugs from other classes. Certain high-risk conditions are compelling
indications for the initial use of other antihypertensive drug classes (angiotensin
converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium
channel blockers).
7. Very important: Adoption of healthy lifestyles by all persons is critical for the
prevention of
high BP and is an indispensable part of the management of those with hypertension.
Major lifestyle modifications shown to lower BP include weight
reduction in those individuals who are overweight or obese,23,24 adoption of
the Dietary Approaches to Stop Hypertension (DASH) eating plan25, which is
rich in potassium and calcium,26 dietary sodium reduction,25–27 physical activity,
28,29 and moderation of alcohol consumption. (See table 5.)30 Lifestyle modifications
reduce BP, enhance antihypertensive drug efficacy, and decrease cardiovascular
risk. For example, a 1,600 mg sodium DASH eating plan has effects
similar to single drug therapy.25 Combinations of two (or more) lifestyle modifications
can achieve even better results.
REFERENCES
Provide a list of references, and proved the link to any on-line resources that the learner
can go to for more information.
Example: http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf