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Domain of Competence: Medical Knowledge

      Imagine a delineation of physician competencies as recently as 25 years ago. Most prominent would have been those related to medical knowledge. Operating in a Flexnerian
      • Flexner A.
      Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching.
      world, knowledge was valued above all else in evaluating both the learner and the teacher. Hodges
      • Hodges B.
      The shifting discourses of competence.
      articulates this concept well in describing the prevailing competence discourse at the time as knowledge discourse, focusing on facts, foundational knowledge, basic science, and fund of knowledge. The learner was guided by classic textbooks and articles and evaluated through multiple-choice tests. The teacher in this model focused on helping students receive or elaborate knowledge. At the time, a physician was often only as effective as the knowledge he carried with him into the clinical encounter.

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      References

        • Flexner A.
        Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching.
        Carnegie Foundation for the Advancement of Teaching, New York, NY1910
        • Hodges B.
        The shifting discourses of competence.
        in: Hodges B. Lingard L. The Question of Competence: Reconsidering Medical Education in the 21st Century. Cornell University Press, Ithaca, NY2012
        • Institute of Medicine
        To Err Is Human: Building a Safer Health System.
        National Academies Press, Washington, DC2000
        • Hojat M.
        • Axelrod D.
        • Spandorfer J.
        • Mangione S.
        Enhancing and sustaining empathy in medical students.
        Med Teach. 2013; 35: e1267-e1301