Competencies and Learning Objectives

Background Information

In 2013, the Association of American Medical Colleges (AAMC) synthesized over 150 competency lists from across medical education continuum, physician specialties and subspecialties, countries and healthcare professions to develop a list of common learner expectations utilized in the training of physicians and other health professionals: Physician Competency Reference Set (PCRS). These competencies define the desired outcomes across the continuum of education, training, and practice.i

The AAMC also developed the 13 Core Entrustable Professional Activities for Entering Residency (EPAs) that all entering residents should be expected to perform on day 1 of residency without direct supervision regardless of specialty choice (see Appendix 1). The EPAs provide the clinical context for the PCRS competencies. Each EPA can be mapped to the competencies that are critical to making an entrustment decision.ii (More information about the EPAs and development of curriculum for the measurement of entrustment is available in the AAMC’s Publication: Core Entrustable Professional Activities for Entering Residency Curriculum Developers Guide: https://members.aamc.org/eweb/upload/Core EPA Curriculum Dev Guide.pdf)

New Institutional Domains of Competency and Competencies

In 2016, Wayne State University School of Medicine analyzed the current institutional learning objectives and decided to revised its competency domains and related competencies for the program leading to the MD degree. As a result, the new AAMC domains of competency were assumed and many institutional competencies changed; in some areas, the previous WSUSOM competencies were maintained but mapped to a PCRS competency and in other areas the new PCRS competencies were adopted. The new domains and competencies are intended to be in line with the AAMC’s PCRS and to map the competencies to the EPAs. WSUSOM Undergraduate Medical Education Curriculum Committee approved the competency domains and competencies on 6/8/2016; they will be instituted beginning with the 2016-2017 academic year.

DOMAIN 1: KNOWLEDGE FOR PRACTICE (KP)

Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 1, 3, 13 KP 1 KP 1: Demonstrate an investigatory and analytic approach to clinical situations
EPA 2 KP 2 KP 2: Apply established and emerging biophysical scientific principles fundamental to health care for patients and populations
EPA 2, 7 KP 3 KP 3: Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision making, clinical problem solving, and other aspects of evidence-based health care
EPA 2, 3, 7 KP 4 KP 4: Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations*
KP 5 KP 5: Apply psychosocial principles and concepts in the delivery of health care, including assessment of the impact of psychosocial-cultural influences on health, disease, care-seeking, care-compliance, and barriers to and attitudes toward care*
KP 6 KP 6: Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 2: PATIENT CARE (PC)

Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 10, 12 PC 1 PC 1: Perform routine technical procedures specified by the medical school and clerkship
EPA 1, 2, 4, 6, 10 PC 2 PC 2A: Take a satisfactory medical history including psychosocial, nutritional, occupational and sexual dimensions
EPA 1, 2, 4, 6, 10 PC 2 PC 2B: Perform a satisfactory physical exam
EPA 1, 2, 4, 6, 10 PC 2 PC 2C: Accurately document the clinical encounter
EPA 10, 11 PC 3 PC 3: Apply the concepts and principles of patient safety science in the delivery of clinical care
EPA 2, 3, 5, 10 PC 4 PC 4A: Apply laboratory and imaging methods in identifying diseases or health problems
EPA 2, 3, 5, 10 PC 4 PC 4B: Interpret laboratory data, imaging studies, and other tests required for the area of practice
EPA 3, 4, 10 PC 5 PC 5A: Utilize data from the history, physical exam and laboratory evaluations, with up-to-date scientific evidence to identify health problems
EPA 3, 4, 10 PC 5 PC 5B: Formulate an appropriate differential diagnosis
EPA 4, 5, 10, 11 PC 6 PC 6A: Formulate effective management plans (diagnostic, treatment, prevention strategies, including relieving pain and ameliorating the suffering of patients) for diseases and other health problems
EPA 4, 5, 10, 11 PC 6 PC 6B: Monitor the course of illnesses and to appropriately revise the management plan
EPA 3, 11, 12 PC 7 PC 7: Counsel and educate patients and their families to empower them to participate in their care and enable shared decision making*
EPA 8 PC 8 PC 8: Understand the need and value of consultations and referrals in the delivery of health care
EPA 3 PC 9 PC 9: Apply preventive and health maintenance principles and techniques in the delivery of health care*
PC 10 PC 10: Provide appropriate role modeling
PC 11 PC 11: Perform supervisory responsibilities commensurate with one’s roles, abilities, and qualifications
PC 12 PC 12: Diagnose and manage patients with common diseases and health-related conditions prevalent in urban settings*

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 3: PRACTICE-BASED LEARNING AND IMPROVEMENT (PBLI)

Demonstrate the ability to investigate and evaluate one’s care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 2, 4, 6, 7 PBLI 1 PBLI 1: Recognize personal educational needs and to select and utilize appropriate resources to optimize learning
PBLI 2 PBLI 2: Set learning and improvement goals
EPA 7 PBLI 3 PBLI 3: Identify and perform learning activities that address one’s gaps in knowledge, skills, or attitudes
EPA 13 PBLI 4 PBLI 4: Systematically analyze practice using quality-improvement methods and implement changes with the goal of practice improvement
EPA 8 PBLI 5 PBLI 5: Incorporate feedback into daily practice
EPA 7 PBLI 6 PBLI 6: Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems
EPA 4, 7, 8 PBLI 7 PBLI 7: Use information technology to optimize learning
PBLI 8 PBLI 8: Participate in the education of patients, families, students, trainees, peers, and other health professionals
EPA 3, 7 PBLI 9 PBLI 9: Obtain and utilize information about individual patients, populations of patients, or communities from which patients are drawn to improve care*
EPA 13 PBLI 10 PBLI 10: Recognize the need to engage in lifelong learning to stay abreast of relevant scientific advances

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 4: INTERPERSONAL AND COMMUNICATION SKILLS (ICS)

Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 1, 4, 5, 6, 11 ICS 1 ICS 1: Effectively interact with patients, peers, families and other healthcare workers from diverse cultural backgrounds*
EPA 2, 5, 6, 7, 8, 9, 10, 13 ICS 2 ICS 2: The ability to effectively communicate with peers and members of the healthcare team in the care of patients and their families
EPA 8, 9 ICS 3 ICS 3: The ability to work cooperatively with other health care workers in the delivery of health care
ICS 4 ICS 4: Act in a consultative role to other health professionals
EPA 5, 11, 12 ICS 5 ICS 5: Maintain comprehensive, timely, and legible medical records
EPA 10, 12 ICS 6 ICS 6: Demonstrate sensitivity, honesty, and compassion in difficult conversations (e.g.. about issues such as death, end-of-life issues, adverse events, bad news, disclosure of errors, and other sensitive topics
EPA 1, 9, 11 ICS 7 ICS 7: Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 5: PROFESSIONALISM (P)

Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 1, 6, 9 P 1 P 1: Demonstrate compassion, integrity, and respect for others, in particular people from vulnerable population*
P 2 P 2: Demonstrate responsiveness to patient needs that supersedes self-interest
EPA 1, 6, 8 P 3 P 3 Respect the patients’ dignity, privacy, and confidentiality in the delivery of health care
EPA 5, 13 P 4 P 4: Demonstrate accountability to peers, patients, society, and the profession
EPA 1 P 5 P 5: Demonstrate sensitivity and responsiveness to diverse populations, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation*
EPA 12 P 6 P 6: Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations
P 7 P 7: Demonstrate credibility, initiative, integrity and professional competence needed to gain the confidence and respect of others while providing clinical care or other services to diverse populations in an urban setting*

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 6: SYSTEMS-BASED PRACTICE (SBP)

Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 5 SBP 1 SBP 1: Describe the health care delivery systems including social, economic and political dimensions
EPA 9 SBP 2 SBP 2: Coordinate patient care within the health care system relevant to one’s clinical specialty
EPA 3, 4, 11, 12 SBP 3 SBP 3: Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population based care*
EPA 13 SBP 4 SBP 4: Advocate for quality patient care and optimal patient care systems to support and contribute to a culture of safety
EPA 13 SBP 5 SBP 5: Participate in identifying system errors and implementing potential systems solution
SBP 6 SBP 6: Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 7: INTERPROFESSIONAL COLLABORATION (IPC)

Demonstrate the ability to engage in an inter-professional team in a manner that optimizes safe, effective patient and population-centered care

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
EPA 9 IPC 1 IPC 1: Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust
EPA 9 IPC 2 IPC 2: Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of the patients and populations served*
EPA 9 IPC 3 IPC 3: Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual patients and populations
IPC 4 IPC 4: Participate in different team roles to establish, develop, and continuously enhance inter-professional teams to provide patient- and population-centered care that is safe, timely, efficient, effective, and equitable*

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

DOMAIN 8: PERSONAL AND PROFESSIONAL DEVELOPMENT (PPD)

Demonstrate the qualities required to sustain lifelong personal and professional growth

Relevant Entrustable Professional Activities Reference to the PCRS WSUSOM Competency
PPD 1 PPD 1: Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors
PPD 2 PPD 2: Demonstrate healthy coping mechanisms to respond to stress
PPD 3 PPD 3: Manage conflict between personal and professional responsibilities
EPA 6 PPD 4 PPD 4: Practice flexibility and maturity in adjusting to change with the capacity to alter behavior
PPD 5 PPD 5: Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients
PPD 6 PPD 6: Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system
EPA 6, 11, 12 PPD 7 PPD 7: Demonstrate self-confidence that puts patients, families, and members of the health care team at ease
EPA 2 PPD 8 PPD 8: Recognize that ambiguity is part of clinical health care and respond by using appropriate resources in dealing with uncertainty

* Represents a WSUSOM Undergraduate Medical Education mission based competency toward urban clinical excellence.

13 Entrustable Professional Activities for Entering Residency

EPA 1: Gather a history and perform a physical examination
EPA 2: Prioritize a differential diagnosis following a clinical encounter
EPA 3: Recommend and interpret common diagnostic and screening tests
EPA 4: Enter and discuss orders and prescriptions
EPA 5: Document a clinical encounter in the patient record
EPA 6: Provide an oral presentation of a clinical encounter
EPA 7: Form clinical questions and retrieve evidence to advance patient care
EPA 8: Give or receive a patient handover to transition care responsibility
EPA 9: Collaborate as a member of an interprofessional team
EPA 10: Recognize a patient requiring urgent or emergent care and initiate evaluation and management
EPA 11: Obtain informed consent for tests and/or procedures
EPA 12: Perform general procedures of a physician
EPA 13: Identify system failures and contribute to a culture of safety and improvement

REFERENCES


i Eglander, R, Cameron, T, Ballard, A, Dodge, J, Bull, J, Aschenbrener, C. Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians: Acad. Med. 2013; 88: 1088-1094

ii Association of American Medical Colleges (AAMC). Core Entrustable Professional Activities for Entering Residency Curriculum Developers’ Guide. 2014; https://members.aamc.org/eweb/upload/Core EPA Curriculum Dev Guide.pdf

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