Questioning medical competence: Should the Covid-19 crisis affect the goals of medical education?

Abstract

The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic’s impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to improving physician training, deliberated how the pandemic raises questions about medical competence. We formulated 12 broad-reaching issues for discussion, grouped into micro-, meso-, and macro-level questions. At the individual micro level, we ask questions about adaptability, coping with uncertainty, and the value and limitations of clinical courage. At the institutional meso level, we question whether curricula could include more than core entrustable professional activities (EPAs) and focus on individualized, dynamic, and adaptable portfolios of EPAs that, at any moment, reflect current competence and preparedness for disasters. At the regulatory and societal macro level, should conditions for licensing be reconsidered? Should rules of liability be adapted to match the need for rapid redeployment? We do not propose a blueprint for the future of medical training but rather aim to provoke discussions needed to build a workforce that is competent to cope with future health care crises.

Keywords:

• Learning outcomes
• outcome-based
• curriculum

Acknowledgments

The concept for this perspective paper originated during a teleconference meeting of the International Competency-Based Medical Education Collaborators, in May 2020.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Olle ten Cate

Olle ten Cate, PhD, is a professor of medical education and a senior scientist at the Center for Research Development of Education, University Medical Center Utrecht, The Netherlands.

Karen Schultz

Karen Schultz MD, is a professor in the Department of Family Medicine, Queen’s University, associate dean of postgraduate education, Queen’s University, Kingston, Ontario, Canada, and chair of the Certification Process and Assessment Committee at the College of Family Physicians of Canada.

Jason R. Frank

Jason R Frank, MD, MA(Ed), is director of specialty education, strategy and standards at the Royal College of Physicians and Surgeons of Canada and vice chair of education in the Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Marije P. Hennus

Marije P. Hennus, MD, PhD, is a pediatric intensivist and program director of pediatric intensive care fellowship, University Medical Center Utrecht, Utrecht, the Netherlands.

Shelley Ross

Shelley Ross, PhD, is an associate professor and director of innovation and research, CBAS Program in the Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada, and is the president of the Canadian Association for Medical Education.

Daniel J. Schumacher

Daniel J. Schumacher, MD, PhD, is an associate professor of pediatrics in the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Linda S. Snell

Linda S. Snell, MD, is a professor of medicine and health sciences education, McGill University, Montreal, Canada, and a senior clinician educator, Royal College of Physicians and Surgeons of Canada.

Alison J. Whelan

Alison J. Whelan is the chief medical education officer at the Association of American Medical Colleges, Washington DC, USA.

John Q. Young

John Q. Young is a professor and the vice chair for education, Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell Health, Glen Oaks, NY, USA.