Regina Kreisle, MD, PhD

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Core Competencies for Medical Student Education
What do Medical Students Need to Know?

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

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Core Competencies for Medical Student Education
What do Medical Students Need to Know?

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

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Core Competencies for Medical Student Education
What do Medical Students Need to Learn (to be
Good Doctors)

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

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Pre-Clinical
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Pre-Clinical
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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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Flexner asks

• What is the necessary starting point?
• Laboratory sciences

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Competency-based approach

• What do you want your end product to be?

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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 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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• Core Competencies ¹ Knowledge Base

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MSOP

• Physicians must be altruistic, altruistic 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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ACGME

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

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Brown UniversityThe Nine Competencies

• 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 Judgment
• VIII. Problem-Solving
• IX. Professionalism and Role Recognition

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Indiana University School of Medicine

• The Indiana Initiative Physicians for the 21st
  Century

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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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Competency-Based Education

• For each of the nine core competencies,
  criteria are established
• Curricular components are developed to address
  and assess these criteria even in basic science
  courses
• Different courses identify and develop different
  aspects of the core 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

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The Competency Agenda

• 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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What core competencies apply to an
undergraduate Pathology curriculum?

• 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 Judgment
• VIII. Problem-Solving
• IX. Professionalism and Role Recognition

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Core competencies to most Basic Science educators

• III. Basic Science Knowledge

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The 5 Myths

• Myth 1
• Our curriculum already values communication and
  professionalismWhy do we need to change it?

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• 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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The 5 Myths

• Myth 2
• There is nothing wrong with our graduates nowwhy
  fix it?

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• Many graduates have no problem with the
  competencies, but that is not universally true.
  Some could do better with feedback and better
  training. Others fail to master necessary
  competencies, but pass because they have mastered
  the knowledge base.

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The 5 myths

• Myth 3
• You cant teach these things. You are either a
  competent communicator or youre not. This is a
  problem for the Admissions Committee.

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• What we are talking about are skills, attitudes,
  and behaviors specific to the practice of
  medicine.

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The 5 Myths

• Myth 4
• Competencies other than knowledge should be
  addressed in the third and fourth years, not in
  basic science courses.

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• Competencies, particularly those that apply to
  the application of knowledge, should be learned
  alongside the knowledge base.
• Incorporation of competencies is as important as
  integration of clinical context in the first two
  years.

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The 5 Myths

• Myth 5
• These things are too subjective you cant
  evaluate them in an objective fashion.
• Corollary you cant assess competencies in a
  large class

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• Objective assessment ¹ multiple choice questions
• Objective assessment necessitates clear criteria
  evaluation of those criteria can be done in a
  variety of settings with a variety of methods

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So What are the Core Medical Competencies that
Need to be Addressed in the Undergraduate Medical
Curriculum (especially by Pathology)?
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Why deal with this at all?

• LCME accreditation requirement each discipline
  must definition its own set of core competencies
  and how the competencies are to be assessed

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Where to start

• Start by asking the question, What are the
  skills, attitudes, knowledge, and behaviors that
  we think are necessary for all graduating medical
  students?

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Next

• What piece(s) are important for Pathology to
  address?
• Alternatively what are the unique opportunities
  that occur in the Pathology curriculum that can
  help students in their mastery of these
  competencies?

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Think about

• Knowledge base
• Skills/applications
• Communication
• Problem-solving
• Data interpretation
• Attitudes
• Professionalism
• Ethics

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Another way to think about it

• What is it that we expect our students to get out
  of
• Lectures
• Laboratory
• Case discussions
• Autopsy experiences

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A thought

• If Pathologists are physicians, and physicians
  should be able to demonstrate a common set of
  core competencies, then all pathologists should
  be able to help their students progress toward
  achievement of any of the core competencies

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• The single most important contribution to the
  learning of medical students is the modeling of
  professional skills, behaviors, knowledge, and
  attitudes by the medical school faculty!

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• Does your curriculum provide opportunities for
  the Pathology faculty to model
• Good communication skills
• Problem solving
• Professionalism
• Life-long learning
• Broad knowledge base

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The Challenge - Assessment

• Identification of core competencies requires
  opportunities for assessment
• Multiple choice examinations are often not
  sufficient to evaluate skills, attitudes, and
  behaviors
• Its difficult to make meaningful assessments of
  skills, attitudes, and behaviors for large groups
  of students

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• Formal assessment adds value to a curricular
  component
• If its important, it should be assessed
• Students learn quickly that things that are not
  assessed are neither valued nor important

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Bottom Line

• Core competencies require a determination of
  desired outcomes
• Core competencies in Pathology should address a
  subset of the general medical competencies
  established for the curriculum as a whole
• While knowledge base is an important component of
  core competencies, it is not the sole component

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Bottom Line, contd.

• Identification and inclusion of core competencies
  should lead to assessment of specific competency
  criteria
• Many competencies cannot be assessed by multiple
  choice exams in the large lecture setting other
  learning and assessment opportunities need to be
  included

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Rather than

• Core Competencies
• General Pathology
• Cell Adaptation
• Necrosis
• Apoptosis
• Cellular accumulations
• Etc.

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Core Competencies Core Values

• Knowledge of disease-associated structural
  changes
• Knowledge of pathophysiology
• Clinical problem solving
• Interpretation of laboratory data
• Interpretation of gross and histopathology
• Appropriate use of descriptive terminology
• Knowledge of the role of the pathologist
• Communication with other members of the health
  care team
• Ability to access relevant information sources
• Ability to incorporate new knowledge as it
  becomes available
• Etc.