CORE COMPETENCIES IN OPHTHALMOLOGY EDWARD RAAB AND ANDREW G. LEE, EDITORS The ACGME Outcome Project in Ophthalmology: Practical Recommendations for Overcoming the Barriers to Local Implementation of the National Mandate Andrew G. Lee, MD, 1,2,4,5,7 Thomas Oetting, MD, 1,6 Hilary A. Beaver, MD, 1 and Keith Carter, MD 1,3 1 Departments of Ophthalmology, 2 Neurology, 3 Otolaryngology, 4 Neurosurgery, 5 H. Stanley Thompson Neuro- ophthalmology Clinic, the University of Iowa Hospitals and Clinics, 6 Veterans’ Affairs Medical Center, Iowa City, Iowa; 7 Department of Ophthalmology, The Methodist Hospital, Houston, Texas and the Task Force on the ACGME Competencies at the University of Iowa Department of Ophthalmology * Abstract. The Accreditation Council for Graduate Medical Education (ACGME) Outcome project is a well-defined, 10-year, ambitious national mandate to improve resident education through the teaching and assessing of six general competencies (i.e., patient care, medical knowledge, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice). Over the past 5 years a Task Force at the University of Iowa has deployed 10 major competency assessment tools: 1) the University of Iowa residency curriculum; 2) direct observation using the Ophthalmic Clinical Exercise (OCEX); 3) journal club; 4) multi-source evaluation; 5) a modified Dreyfus scale faculty global evaluation form; 6) the Iowa Cataract surgical curriculum; 7) the Iowa Ophthalmic Laser curriculum; 8) traditional written and oral examinations; 9) self reflection exercises and projects; and 10) learner portfolio. We report our 5-year experience with an implementation matrix for translating the national ACGME mandate into local compliance. We identify the barriers encountered by our Task Force in local implementation and propose practice solutions based upon our experience for overcoming the cultural, institutional, financial, and other barriers to success. We hope that our institutional work and experience will stimulate other programs to participate more fully in the ACGME Outcomes Project. (Surv Ophthalmol 54:507--517, 2009. Ó 2009 Elsevier Inc. All rights reserved.) At the time of the writing of this article, it will have been 7 years since the inception of the Accreditation Council for Graduate Medical Education (ACGME) Outcomes Project. The ACGME Outcome project set forth an ambitious national mandate to improve resident education through the teaching and assessing of six competencies (i.e., patient care, medical knowledge, professionalism, interpersonal * The Task Force on the ACGME Competencies includes the authors of the manuscript as well as Michael Abramoff, MD, H. Culver Boldt, MD, Emily Greenlee, MD, A. Tim Johnson, MD, and Richard Olson, MD. 507 Ó 2009 by Elsevier Inc. All rights reserved. 0039-6257/09/$--see front matter doi:10.1016/j.survophthal.2009.04.004 SURVEY OF OPHTHALMOLOGY VOLUME 54  NUMBER 4  JULY–AUGUST 2009