The sick care competency conundrum

Dr Sandeep Jauhar, a physician author of a recent NY Times Op-Ed article asks, "How would you feel about a 100-year old doctor?". He claims mandatory retirement at a certain age is not the answer. Instead, he advocates for periodic competency assessments.

For a start, the definition of competency varies. One is a set of demonstrable characteristics and skills that enable, and improve the efficiency of, performance of a job. Competencies are not skills, although they are similar. Skills are learned, while competencies are inherent qualities an individual possesses – collaboration skills, knowledge, and ability.

In short, knowledge is defined as the understanding of facts, concepts, and information. Skills are defined as abilities to carry out tasks. Attitudes are settled ways of thinking or feeling about something. 

Here is a list of entrepreneurial competencies. Have some been omitted?

Here are the ACGME (Accreditation Council for Graduate Medical Education) core competencies. Do you see any that are missing and that you wished you had developed during medical school, like being able to practice the business of medicine using a viable business model?

Here is an attempt to define digital health competencies for medical students.

What knowledge, skills, attitudes and competencies should medical professionals have about artificial intelligence?

Blood pressure measurement is the most performed procedure in clinical practice, yet research has shown that medical students routinely fail on more than half the skills required. This cannot come as much of a surprise, however, given that the training they get is usually limited to one-time, textbook-based efforts that occur early in medical school and do not cover self-measured blood pressure (SMBP). Medical education desperately needs a solution to address this gap in the curriculum. e-Learning might help.

What is competency-based education and training?

Competency based medical education, training and assessment is in its beginning stages.

Implementing competency-based assessments for physicians at scale must address several issues:

1. Reforming sick care professional workforce education and training from the undergraduate level to an entire clinician's career
2. Overcoming academentia and the resistance to change
3. Training the trainers
4. Legal and ethical issues
5. The cost of such assessments
6. Jurisdictional issues and federal v state boards of medical examiner and specialty society oversight
7. Reforming standardized tests required for medical licensure and specialty board certification, including all the issues that have surfaced about maintenance of certification (MOC)
8. The time and effort required to implement CBME during a time when stakeholders are asking for cheaper and faster medical education and training
9. Scope of practice creep competency variables
10. Accountability and remedies for failure to demonstrate a certain competency
11. Public disclosure of results for individual clinicians
12. Medical school, residency training and board accreditation and certification processes that rely on measures that are not competency based
13. Including competencies that are ever changing market and technology drivers, e.g. artificial intelligence, analytics, and data literacy, sick care systems science, diversity, equity, and inclusion, ESG competencies and others that might be included in MedEd2030.
14. Credentialing and measuring competence to use medical devices, perform new operations or variants of existing devices e.g. the distinct kinds of lasers and surgical robots
15. Monitoring teaching, research, community service and administrative competencies along with clinical care competencies as part of an overall whole competency assessment for a compensation formula or promotion and tenure criteria.

New educational technologies, like chatbots, might help us deploy personalized learning at scale,

Creating competency-based outcomes assessments that are consistent, accountable, publicly disclosed, data driven and equitable that span the entire spectrum of health professional learning throughout their clinical careers is an unrealistic short-term expectation. As of now, it is an educational experiment and the results have been mixed. Like any experiment, the medical education and training establishment should do pilots and report their results. You should always test your new business ideas and you never know how, when or who will use your product.

Not everything that matters can be measured and not everything that can be measured matters-Albert Einstein

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs