Accreditation Council for Graduate Medical Education (ACGME) Competencies

We are committed to providing residents and fellows with an educational environment that allows a resident or fellow to demonstrate to the satisfaction and understanding of the faculty, the following attributes and objectives as set forth by the Accreditation Council for Graduate Medical Education (ACGME).

Each residency program enables its residents to develop competencies in 6 areas. Toward this end, programs define the specific knowledge, skills, and attitudes required, and provide educational experiences as needed, in order for their residents to demonstrate the competencies.

As specified in the ACGME Common Program Requirements, all Dartmouth Hitchcock Medical Center training programs have integrated the general competencies into written curriculum and evaluations related to education and clinical care. Programs use resident performance data as the basis for program improvement and provide evidence for accreditation review. Programs are expected to use external measures (e.g., clinical quality indicators, patient surveys, employer evaluations of graduates, national and specialty standardized measures) to verify resident and program performance levels.

The 6 core competencies and sub-competencies, as defined by the ACGME, are as follows:

Patient care

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. Residents are expected to:

  • Communicate effectively and demonstrate caring and respectful behavior when interacting with patients and their families
  • Counsel and educate patients and their families
  • Develop and carry out patient management plans
  • Gather essential and accurate information about their patients
  • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
  • Perform competently all medical and invasive procedures considered essential for the area of practice
  • Provide health care services aimed at preventing health problems and maintaining health
  • Use information technology to support patient care decisions and patient education
  • Work with health care professionals, including those from other disciplines, to provide patient-focused care 
  • [as further specified by each ACGME Review Committee]

Medical knowledge

Residents must demonstrate knowledge about established and evolving biomedical, clinical epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

  • Demonstrate an investigatory and analytic thinking approach to clinical situations
  • Know and apply the basic and clinically supportive sciences which are appropriate to their discipline 
  • [as further specified by each ACGME Review Committee]

Practice-based learning and improvement

Residents must demonstrate the ability to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals:

  • Analyze practice experience and perform practice-based improvement activities using a systematic methodology
  • Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
  • Facilitate the learning of students and other health care professionals;
  • Locate, appraise, and assimilate evidence from scientific studies related to their patients' health problems
  • Obtain and use information about their own population of patients and the larger population from which their patients are drawn
  • [as further specified by each ACGME Review Committee]

Interpersonal and communication skills

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to:

  • Act in a consultative role to other physicians and health professionals
  • Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds
  • Communicate effectively with physicians, other health professionals, and health-related agencies
  • Create and sustain a therapeutic and ethically sound relationship with patients
  • Maintain comprehensive, timely, and legible medical records, if applicable.
  • Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
  • Work effectively as a member or leader of a health care team or other professional groups
  • [as further specified by each ACGME Review Committee]


Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles and a sensitivity to a diverse patient population. Residents are expected to demonstrate:

  • Accountability to patients, society, and the profession
  • Commitment to ethical principles
  • Compassion, integrity, and respect for others
  • Respect for patient privacy and autonomy
  • Responsiveness to patients needs that supersede self-interest
  • Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
  • [as further specified by each ACGME Review Committee]

Systems-based practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to effectively call on other resources to provide optimal health care. Residents are expected to:

  • Advocate for quality patient care and assist patients in deal with system complexities
  • Participate in identifying system errors and implementing potential systems solutions
  • Partner with health care managers and health care providers to assess, coordinate
  • Practice cost-effective health care and resource allocation that does not compromise quality care
  • Work effectively in various health care delivery settings and systems relevant to their clinical specialty
  • Work in interprofessional teams to enhance patient safety and improve patient care quality
  • [as further specified by each ACGME Review Committee]