Background: Residency programs must prepare physicians to practice in the current health care environment. This mandate is reflected in 3 of the 6 competency domains now required by the Accreditation Council for Graduate Medical Education: systems-based practice, interpersonal skills and communication, and practice-based learning and improvement. Summary: An invitational conference was convened, with experts in clinical practice, managed care administration, and education to identify and recommend optimal and promising assessment methods for 4 target areas: physician-patient communication, ethics, teamwork and collaboration, and practice management. Working in small groups, participants considered a range of resident assessment methods and identified current or future methods for each area, based on reliability, validity, use of behaviorally oriented outcomes, feasibility, and cost. Preferred methods of assessment varied by domain and include written examinations, computer-based patient management problems, standardized patients, objective structured clinical examinations, portfolios, 360° evaluations, and patient satisfaction surveys. Conclusions: The use of several practical, scientifically sound, and specific methods for assessing residents' competency in care management are recommended. Assessment instruments will need to be flexible enough to adapt to the rapid changes in the health care delivery system and terminology.
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