Striving for Success
In 1992 the School of Medicine initiated a process of curricular
review. This arose not from a conviction that the curriculum was
seriously flawed but from the desire always to improve it. One outcome
was “the competencies.”
The term “competencies” now is used by medical schools
and, by recent mandate, residency-training programs. It derives
from a goal that most educators can embrace: At a minimum, our learners
must be competent to proceed to the next stage of their lives when
they complete our training program.
Our faculty has agreed that competence means our learners must
be able to communicate effectively in medical settings, perform
proficiently certain basic clinical skills, know and use scientific
knowledge to guide medical care, know how and show ability to be
a lifelong learner; show awareness of their individual strengths
and weaknesses and take appropriate self-care; recognize and respond
to the social and community contexts of healthcare; recognize the
ethical complexity of medicine; attempt to understand and analyze
conflicting views and maintain personal ethical integrity; recognize,
characterize, and resolve problems effectively; and understand the
meaning and importance of professionalism and become competent in
its practice.
Where are we in this challenging process?
Our students are now well aware of these expectations. We inform
them at freshman orientation and at many later points during their
studies. We introduce methods to train them and to measure these
abilities, including objective structured clinical examinations
using standardized patients, formal multi-day problem-solving activities
(triple-jump exams), additional facilitated small-group learning
activities, required electronic logging of successfully performed
or observed procedures, and increasing time where faculty and residents
observe students in working interactions with patients.
In some instances course directors have introduced new content
into the curriculum. On occasion, our increased emphasis on professionalism
and self-awareness and self-care has led to earlier delineation
and remediation of students’ problems in these areas and has
led some faculty members to think more deeply about their own role-modeling
behaviors.
Faculty and students recognize that the curriculum still does not
always provide adequate guidance and resources to achieve competency
as fully as we desire. We appreciate the need for additional faculty
development activities and curricular restructuring.
Although the skills, values, attitudes and behaviors we defined
can be difficult to assess, it is important to do so. The School
certifies – and patients should expect – that our graduates
have these skills and behaviors. We are not perfect in teaching
and evaluating these attributes, but the competency curriculum has
pushed us to do a better job than ever before.
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