Over the past several years, medical educators have begun to identify a set of core medical competencies that are essential to the education of competent physicians.  These general medical competencies include skills in communication, problem-solving, and life-long learning, as well as other professional attitudes and behaviors.  Currently over half of all medical schools in the United States identify some subset of core competencies in their medical education objectives or mission statements.  In 2002, the Accreditation Council for Graduate Medical Education began to require the formal assessment of core competencies in all residency programs.  The current question appears to be not whether core competencies should be assessed as part of the medical school curriculum, but which competencies should be addressed and how should they be evaluated.

While many schools acknowledge the importance of core competencies, few schools include assessment of competencies as a formal part of the medical education process.  Pioneers in incorporating competency assessment into the undergraduate medical curriculum include McMaster University and Brown University.  In 1997, the Indiana University School of Medicine adopted a new curriculum based on the same list of nine general medical competencies used at Brown University.  A major objective of the new curriculum was to incorporate core competencies, including formal means of assessment, at all levels of the curriculum.  Basic science educators, who were comfortable with teaching and assessing basic science knowledge, were suddenly faced with implementing a curriculum that incorporated eight additional areas of skills and behaviors.  Because all nine competencies were integrated throughout the curriculum, relegating assessment of the competencies to clinical rotations was not an option.  Every course was asked to identify at least one competency other than basic science knowledge for formal assessment.  Most basic science faculty focused on communication skills, lifelong learning skills, or problem-solving skills as their chosen competency.  Many basic scientists were surprised to learn that elements of professionalism, clinical skills, and medical ethics could also be evaluated in their courses.  Once specific criteria for a given competency were identified, appropriate methods of assessment could be developed.  In many cases, faculty found that their course already included multiple opportunities for assessment.  Communications skills, for instance, could be assessed as part of oral presentations, discussions, or written assignments.  Problem-solving was a key element in many laboratories or case-based discussions.  However, faculty who depended solely on multiple choice examinations for assessment had to develop new assessment methods and tools.  In spite of these many challenges, the basic science faculty now play an essential role in developing and evaluating core competencies.  In May of 2003, Indiana University School of Medicine will graduate its first class to experience all four years of the competency-based curriculum.

In this IAMSE audio seminar, Dr. Kreisle introduced the concept of general medical competencies and outlined recent trends to incorporate these competencies into undergraduate medical education.  She related her experience as Competency Director for one of the regional campuses of the Indiana University School of Medicine and offered practical suggestions for the implementation and assessment of these competencies as part of the basic science curriculum.