Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

Abstract

PurposeThere have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on ‘doing the work of a physician’ rather than identity formation and ‘being a physician.’ This study aims to understand how competency-based education impacts the development of a medical student’s identity.MethodsThree ceramic models representing three core competencies ‘medical knowledge,’ ‘patient care,’ and ‘professionalism’ were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes.ResultsStudents across all four years of medical school related to the ‘professionalism’ competency domain (50%). They reflected that ‘being an empathetic physician’ was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized ‘professionalism’ as a competency.ConclusionStudents perceive ‘professionalism’ as a competency that impacts their identity formation in the social role of ‘being a doctor,’ albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians

“…These KCs, therefore, can be difficult to measure and assess [ 44 ]. In addition, aside from personal interpretations, there was also the complexity of assessing and judging the level of achievement required for a KC in order to work as a physician, with the duties and responsibilities of the profession [ 52 ]. These biases in the definition of assessment and attainment could blur viewpoints about a competency and the best time frame for its achievement.…”

Identification and evaluation of the core elements of character education for medical students in Korea

“…Although numerous previous studies have shared experiences with curricula on medical professionalism, medical ethics, community services, medical humanities, and communication skills, and have addressed the necessity of character education [6-10], it is difficult to find studies directly dealing with the current problems in character education and suggesting alternatives for medical education. In order for medical students to develop an identity as a doctor, their academic, clinical, and patient-related competencies are all important, and these 3 factors must be well-balanced [11]. With this in mind, it is necessary to examine whether the current medical education system is appropriate for producing good doctors, and in particular, whether character education is included along with medical knowledge and skills.…”

Understanding the Needs and Preferences of Domestic and Sexual Violence Education for Health Profession Students

“…This study is unique as it is the first study we are aware of that assesses the learning needs and preferences on domestic and sexual violence among health profession students representing various disciplines at the same institution. Health profession students are a unique group of individuals who are actively building their clinical skills and attitudes, which shape their future clinical manner and practices (Feldman & Chawla, 2015; Gonsalves & Zaidi, 2016). This study reveals health profession students’ comfort, attitudes, and perceived knowledge on domestic and sexual violence widely vary at the same institution.…”