For many years significant changes in residency education in the US have occurred primarily in the required curriculum for each specific training discipline. Now, residency training is undergoing dramatic revision across all graduate medical education programmes as part of the General Requirements for Graduate Medical Education. Two issues are driving this change—the assessment of resident education based on a set of general competencies, and a “legislated” reduction in work hours.

In the US, residency training is under the direction of the Accreditation Council for Graduate Medical Education (ACGME). ACGME establishes the core training requirements for all accredited postgraduate training programmes. These core requirements are clearly articulated and include the requirements for sponsoring institutions. Within its mandate for establishing these core requirements, ACGME has developed two major revisions that must now be incorporated and instituted by all programmes in order to remain accredited.

In February 1999, ACGME announced its recommendations for outcome assessment of trainees. This is highlighted by the ACGME requirement that all accredited programmes must measure resident competency in the following areas:

• Patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

• Medical knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care.

• Practice based learning and improvement that involves investigation …