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ACGME Core Competencies: The 6 and How Interviews Test Them
The six ACGME core competencies are Professionalism, Patient Care and Procedural Skills, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Systems-Based Practice. Every US residency must teach and assess all six, and residency interview questions are built around them. Below, each one with an interview question and the outline of a strong answer.
What the ACGME core competencies are
The ACGME accredits US residency programs, and its Common Program Requirements, effective July 1, 2026, set out the six competencies. “The Competencies provide a conceptual framework describing the required domains for a trusted physician to enter autonomous practice.” The requirements also say “The program must integrate all ACGME Competencies into the curriculum.” Programs must give each resident “an objective performance evaluation based on the Competencies and the specialty-specific Milestones”. A proposed major revision, posted for comment on September 8, 2026 with a proposed effective date of July 1, 2028, keeps the same six.
Interviewers rarely name the competencies. They ask behavioral and situational questions, and each one lands in one or two of the six. Prepare one or two stories for each competency and you are ready for most of what a program asks.
The six competencies and how interviews test them
Professionalism
What the ACGME means. The requirements (section 4.3) ask for “a commitment to professionalism and an adherence to ethical principles”. Integrity, compassion and respect for every patient, accountability, protecting privacy, handling conflicts of interest, and taking care of your own well-being.
How interviewers test it. Ethics scenarios about a colleague, questions about patients you found hard to care for, and questions about stress and well-being.
Example question. Before a shift, you notice your senior resident smells of alcohol. What do you do?
A strong-answer pattern:
- Name the risk first: patient safety comes before loyalty to a colleague.
- Say what you would do now, privately and with respect for your senior.
- Escalate to the attending or program director if the risk stays, and say why.
- Close on support for the colleague, not punishment.
Patient Care and Procedural Skills
What the ACGME means. The requirements (sections 4.4 and 4.5) ask for “patient care that is patient- and family-centered, compassionate, appropriate, and effective for the treatment of health problems and the promotion of health”. Care that is safe, effective and centered on the patient and family, plus the procedures your specialty needs. The requirements split it into two parts: patient care and procedures.
How interviewers test it. Prioritization stories from busy shifts, a patient who got worse, how you involve patients in decisions, and how you learn a procedure.
Example question. Tell me about a shift when several sick patients needed you at once. How did you prioritize?
A strong-answer pattern:
- Set the scene in two sentences: how many patients, who was sickest.
- Walk through how you sorted them and who you called for help.
- Give the outcome, then what you would do the same way next time.
Medical Knowledge
What the ACGME means. The requirements (section 4.6) ask for “knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences”. Knowing the biomedical, clinical, epidemiological and social sciences behind your specialty, and applying that knowledge to the patient in front of you.
How interviewers test it. Scores and letters carry most of it. In the interview, a case you reasoned through out loud and a time you knew your limits.
Example question. Describe a time you recognized the limits of your clinical knowledge. What did you do next?
A strong-answer pattern:
- Pick a real moment when you were unsure, not a dramatic error.
- Say how you noticed the gap and who or what you checked with.
- End on what you now look up or ask about earlier.
Practice-Based Learning and Improvement
What the ACGME means. The requirements (section 4.7) ask for “the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning”. Looking honestly at your own care, finding the gaps, using feedback and evidence to close them, and improving the system through quality improvement work.
How interviewers test it. Feedback and failure questions, how you find evidence for a patient, and any quality improvement project on your application.
Example question. What did you learn the last time you received harsh feedback?
A strong-answer pattern:
- Quote the feedback plainly, without defending yourself.
- Show the concrete change you made and how you checked it worked.
- Link it to how you plan to use feedback as a resident.
Interpersonal and Communication Skills
What the ACGME means. The requirements (section 4.8) ask for “interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals”. Exchanging information well with patients, families and colleagues: across languages and backgrounds, in handoffs and consults, in teaching, and in conversations about goals of care.
How interviewers test it. Hard conversations, working with an interpreter, handoffs and consults. How you answer every question counts too.
Example question. Tell me about a time you had to deliver difficult news to a teammate or a patient's family.
A strong-answer pattern:
- Say how you prepared: the setting, who was in the room, what they already knew.
- Describe the pause and the questions you asked, not just what you said.
- Close with how you checked understanding and what came next.
Systems-Based Practice
What the ACGME means. The requirements (section 4.9) ask for “an awareness of and responsiveness to the larger context and system of health care, including the social determinants of health”. Seeing the system around the patient: coordinating care across settings, social determinants of health, cost and value, and finding and fixing system errors.
How interviewers test it. Discharges and transfers, social needs that changed an outcome, cost and value, and how you would fix a system error.
Example question. Tell me about a transition of care you were involved in, such as a discharge or a transfer. How did you help make it safe?
A strong-answer pattern:
- Name the gap in the system, not just the patient's problem.
- Show the people you pulled in: nurses, case managers, the next team.
- Say what you would change so the next patient is safer.
“Tell me about a time you failed. What did you do next?”
A strong answer owns one real mistake in a sentence, spends most of its time on what you changed, and shows the change held up.
More questions for each competency
More residency questions that test each competency, from our question bank and our specialty pages. Open one to see the list.
Professionalism
- You overhear a resident making an inappropriate joke about a patient. What do you do in the moment?
- A convicted child molester comes to your ER needing emergency surgery. Do you treat him the same as everyone else?
- How do you manage stress?
- Tell me about a time you were exhausted and still had to perform. How did you keep your patients safe?
- How do you look after your own mental health, given the stories you will hear every day?
Patient Care and Procedural Skills
- Tell me about a patient whose ability to make decisions was in question. How did the team handle consent?
- Walk me through how you would triage patients after a multi-car collision.
- How do you practice and improve a technical skill? Give me a concrete example.
- Tell me about a resuscitation you were part of. What was your role, and what went well or poorly?
Medical Knowledge
Practice-Based Learning and Improvement
Interpersonal and Communication Skills
- How would you communicate with a patient who has limited English proficiency?
- Role-play: A patient's daughter, played by an actor, is angry that her mother has waited four hours in the emergency department. Talk with her.
- Describe a goals-of-care conversation you took part in. What was your role, and what did you learn?
- Tell me about a time you explained a diagnosis to a parent who spoke limited English.
Systems-Based Practice
- Describe a time you saw a social determinant of health change a patient's outcome.
- What kind of community do you want to practice in, and what have you done to prepare for it?
- Tell me about handing off a patient at the end of a shift with the workup still pending. How did you make sure nothing was missed?
- Tell me about a time you addressed a social need, like food, housing, or transportation, that was affecting a patient's health.
The Milestones
Each specialty turns the six competencies into its own Milestones. In the ACGME's Milestones Guidebook for Residents and Fellows, “From Level 1 to Level 5, the Milestones describe a stepwise progression toward achieving mastery”. Level 1 is a starting resident, and “Level 4 is an ideal graduation target”, though the ACGME does not require it. The program director reviews your progress along the Milestones at least every six months. The guidebook's advice to residents: “Perform a Milestone self-assessment twice a year”. The next Milestones mid-year reporting window runs October 26, 2026 to January 8, 2027. As an applicant you will not be rated on them, but they show what programs expect you to grow into.
How to prepare
- Write down 8 to 10 stories from clerkships, sub-internships and research, and tag each with the competencies it shows.
- Fill the gaps, so every competency has at least one story, including Systems-Based Practice and Practice-Based Learning.
- Outline each story in a few lines: the situation, what you did, the result, what you changed. Do not script it word for word.
- Say them out loud with follow-up questions. Our residency interview questions and behavioral questions guides list what programs ask, and you can practice by specialty on our residency page.
More residency guides are in our residency interview guides. Matching in Canada? See the CanMEDS roles.
Sources: the ACGME Common Program Requirements (Residency), effective July 1, 2026, its proposed major revision, the Milestones Guidebook for Residents and Fellows and the Milestones overview. All checked October 25, 2026.
Frequently asked questions
What are the 6 ACGME core competencies?
Professionalism, Patient Care and Procedural Skills, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, and Systems-Based Practice. Every ACGME-accredited residency must build all six into its curriculum.
Do residency interviewers ask about the competencies by name?
Rarely. They ask behavioral and situational questions, and most of those land in one or two competencies. Knowing the six helps you pick the right story and check that your stories cover all of them.
What are the ACGME Milestones?
Each specialty describes progress in the six competencies in five levels, from a starting resident at Level 1 to a role model at Level 5. Programs rate residents on them twice a year, and Level 4 is the ideal graduation target.
Are the ACGME core competencies changing?
Not the six. A major revision of the Common Program Requirements was posted for comment on September 8, 2026, with a proposed effective date of July 1, 2028, and it keeps the same six competencies.
How are the ACGME competencies different from AAMC competencies and CanMEDS?
The AAMC competencies describe what medical schools look for in applicants. The ACGME competencies describe what US residencies must teach and assess. CanMEDS is the Canadian framework of physician roles. Matching in Canada? See the CanMEDS roles.