What are General Medical Competencies and Why Should I Care

1
What are General Medical Competencies(and Why
Should I Care)?

• Regina Kreisle, MD, PhD
• Purdue University
• Lafayette Center for Medical Education
• Indiana University School of Medicine

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Objectives

• Define General Medical Competencies
• Explain origins of this curricular approach
• Explain how this approach differs from most
  current undergraduate curricula

3
Objectives

• Discuss the likely evolution of Competency
  requirements in undergraduate medical education
• Describe ways in which General Medical
  Competencies can be incorporated into
  undergraduate Pathology Education

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What is a Competency?

• Competencies encompass knowledge, attributes,
  skills, attitudes, and behaviors necessary for a
  particular set of tasks or objectives

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General Medical Competencies

• What are the knowledge, attributes, skills,
  attitudes, and behaviors that all students should
  demonstrate when they graduate from medical
  school?

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Knowledge Attributes Skills Attitudes Behaviors
Objectives Tasks
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Medical School Objectives Project (AAMC)

• The Medical School Objectives Project (MSOP) is
  an initiative designed to reach general consensus
  within the medical education community on the
  skills, attitudes, and knowledge that graduating
  medical students should possess.

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MSOP Report

• In recent years, many observers of medicine have
  expressed concerns that new doctors are not as
  well prepared as they should be to meet societys
  expectations of them
• http//www.aamc.org/meded/msop/msop1.pdf

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MSOP Project

• to develop a consensus within the medical
  education community on the attributes that
  medical students should possess at the time of
  graduation, and set forth learning objectives for
  the medical school curriculum derived from those
  attributes.

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This statement DOES NOT SAY

• to develop a consensus within the medical
  education community on the knowledge that medical
  students should possess at the time of
  graduation, and set forth learning objectives for
  the medical school curriculum that define the
  knowledge base.

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MSOP Report

• The goal of medical education is to produce
  physicians who are prepared to serve the
  fundamental purposes of medicine. To this end,
  physicians must possess the attributes that are
  necessary to meet their individual and collective
  responsibilities to society.

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MSOP

• Physicians must be altruistic, compassionate, and
  truthful.
• Physicians must be knowledgeable about the
  scientific basis of medicine.
• Physicians must be skillful in communicating with
  and caring for patients.
• Physicians must be dutiful in working with other
  to promote the health of individual patients and
  the broader community.

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List of Facts Students Need to Know
Medical School Learning Objectives
¹
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Competence

• the habitual and judicious use of
  communication, knowledge, technical skills,
  clinical reasoning, emotions, values, and
  reflections in daily practice for the benefit of
  the individual and community being served.
• Epstein and Hundert
• JAMA, Jan. 9, 2001

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ACGME

• Patient care
• Medical knowledge
• Practice-based learning and improvement
• Interpersonal and communication skills
• Professionalism
• Systems-based practice

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ACMC

• The core values of professionalism (the social
  contract between professional and society) are
  scientific expertise and altruism.
• http//www.hc-sc.gc.ca/hppb/healthcare/pubs/socia
  l_accountability/index.html

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Social Accountability, contd.

• A well-rounded professional demonstrates
  knowledge, clinical competence, lifelong
  learning, evidence-based practice,
  interdisciplinary teamwork, balance between
  disease management and disease prevention/health
  promotion, professional and ethical behavior in
  practice, optimal use of resources and
  consciousness of well-being of self and
  colleagues.

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May 2002

• Shifting Paradigms From Flexner to
  Competencies.
• Carraccio, C, SD Wolfsthal, R Englander, K
  Ferentz, and C Martin.
• Acad. Med. 200277361-367.

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Arent our graduates competent now?

• Were good at defining and assessing the
  knowledge part of educating competent physicians
• Historically, we acknowledge the other
  components, but dont define or assess them in a
  formal manner

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Why fix it?

• In fact, traditional medical education has always
  valued demonstration of skills and attitudes
• Problem formal curricular assessment emphasizes
  knowledge base with only cursory and subjective
  assessment of other necessary competencies

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Competency-Based Education

• Implies that skills, attitudes, and behaviors are
  as important as knowledge base
• Incorporates formal assessments of desired
  competencies
• Competencies are woven throughout curriculum

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The Competency Agenda

• Overt agenda provide better preparation in all
  aspects of knowledge, attitudes, and skills
  necessary for the practice of medicine
• Covert agenda identify (and potentially
  remediate) problems that would otherwise be
  missed in assessing knowledge base alone (usually
  in only about 5 of students)

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Indiana University School of Medicine

• The Indiana Initiative Physicians for the 21st
  Century

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IUSM Competency Curriculum

• We expect our students to strive for the
  qualities of altruism, honesty, compassion,
  respect, responsibility, accountability, and
  excellence.
• The content of the curriculum is expected to
  present, foster, and evaluate these qualities in
  all of our students throughout all four years.

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But what does that have to do with teaching
Pathology?!!!
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The Nine Competencies (Brown University)

• I. Effective Communication
• II. Basic Clinical Skills
• III. Basic Science Knowledge
• IV. Lifelong Learning
• V. Self-Awareness and Self Care
• VI. Social and Community Context of Health Care
• VII. Moral Reasoning and Ethical Judgement
• VIII. Problem-Solving
• IX. Professionalism and Role Recognition

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The Nine Competencies (Brown University)

• I. Effective Communication
• II. Basic Clinical Skills
• III. Basic Science Knowledge
• IV. Lifelong Learning
• V. Self-Awareness and Self Care
• VI. Social and Community Context of Health Care
• VII. Moral Reasoning and Ethical Judgement
• VIII. Problem-Solving
• IX. Professionalism and Role Recognition

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Competencies in Pathology

• I. Effective Communication
• II. Basic Clinical Skills (data interpretation)
• III. Basic Science Knowledge
• IV. Lifelong Learning
• VIII. Problem-Solving
• IX. Professionalism and Role Recognition

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Analogy with Graduate Curriculum

• A PhD graduate is expected to be able to
• Communicate research results
• Be an expert in his/her field
• Develop good scientific method
• Demonstrate ethical conduct of research
• Write a research grant
• Work in collaborative relationships

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The Challenge - Assessment

• New curricular objectives must be created to
  encompass skills, attitudes, and behaviors (other
  than demonstration of knowledge) including
  application of knowledge
• Multiple choice examinations are often not
  sufficient to evaluate skills, attitudes, and
  behaviors

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The real question

• What does this have to do with me and my course?

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Coming to a Medical School Near You

• ACGME currently requires evaluation of core
  medical competencies in graduate programs
• MSOP is finalizing recommendations for its
  consensus of medical school objectives
• Medical schools are re-defining their mission
  statements and educational objectives to include
  general medical competencies
• LCME is pushing for better defined core
  discipline competencies and ways to assess them

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Coming to a Medical School Near You

• It is likely that in the very near future,
  accreditation of undergraduate medical education
  programs will require that general medical
  competencies be addressed (defined and assessed)
  throughout the curriculum, including the basic
  sciences and Pathology education

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Take Home Message

• The Pathology curriculum will be expected to
  reflect general medical competencies in addition
  to core knowledge objectives
• Pathology courses can (and should) include
  competencies such as communication skills,
  problem-solving, lifelong learning and knowledge
  application

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Take Home Message, contd.

• New objectives may necessitate new forms of
  evaluation and assessment
• Its better to embrace what aspects you are best
  able (and willing) to develop in the curriculum
  rather than wait until unwanted requirements are
  forced on you (and that day is coming)

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Where to start

• What attitudes, skills, and behaviors will be
  necessary for my students to incorporate a
  knowledge of Pathology into their roles as
  physicians?
• Which of these competencies are not currently
  being addressed/assessed?

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How can my course better develop

• communication skills (vocabulary, writing, oral
  presentation, etc.)
• lifelong learning skills (exploration of
  resources beyond the textbook, summary of
  researched information, etc.)
• problem-solving skills (interpretation of
  information and hypothesis testing)
• professionalism and role recognition (familiarity
  with Pathology as a discipline/specialty,
  modeling of professional behavior by faculty,
  etc.)

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Academic Medicine, June 2004