Domains of Competency

The overall goal of medical education at the medical school is to train physicians across the continuum from medical school through residency and into practice to be outstanding clinicians, leaders, educators, advocates, and researchers. The medical student curriculum is guided by the eight domains of competency, which are statements of the complex knowledge, skills, attitudes, behaviors, and values applied to specific situations. Medical students are required to exhibit the appropriate level of competency for each of the 58 required educational competencies across all eight domains as evidence of their achievement of completing the MD program. Objectives are stated for each competency and are behavioral statements describing the goals of instruction. The competencies guide the learning objectives of each event, which inform both the learning activities and the associated assessments.

The competencies underscore that the practice of medicine is simultaneously both an art and a science, and that these separate elements must be integrated through the knowledge, skills, attitudes, behaviors, and values of each individual physician graduate. The medical school provides a competency-based education using a course‑based approach with competencies across eight domains that prepares graduates to achieve these goals (Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA: Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Acad Med 2013:88:1088-1094).

Medical students must achieve and demonstrate individually by the time of graduation all of the knowledge, skills, attitudes, behaviors, and values embodied in each of the 58 required educational competencies across the eight domains.

  1. Patient Care
  2. Knowledge for Practice
  3. Practice-Based Learning and Improvement
  4. Interpersonal and Communication Skills
  5. Professionalism
  6. Systems-Based Practice
  7. Interprofessional Collaboration
  8. Personal and Professional Development

1. Patient Care

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

  • 1.1 Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.
  • 1.2 Gather essential and accurate information about patients and their conditions through history taking, physical examination, and the use of laboratory data, imaging, and other tests.
  • 1.3 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient.
  • 1.4 Interpret laboratory data, imaging studies, and other tests required for the area of practice.
  • 1.5 Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
  • 1.6 Develop and carry out patient management plans.
  • 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making.
  • 1.8 Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes.
  • 1.9 Provide healthcare services to patients, families, and communities aimed at preventing health problems or maintaining health.
  • 1.10 Provide appropriate role modeling.
  • 1.11 Perform supervisory responsibilities commensurate with one’s roles, abilities, and qualifications.

2. Knowledge for Practice

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

  • 2.1 Demonstrate an investigatory and analytic approach to clinical situations.
  • 2.2 Apply established and emerging biophysical scientific principles fundamental to health care for patients and populations.
  • 2.3 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.
  • 2.4 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.
  • 2.5 Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care.
  • 2.6 Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices.

3. Practice-Based Learning and Improvement

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.

  • 3.1 Identify strengths, deficiencies, and limits in one’s knowledge and expertise.
  • 3.2 Set learning and improvement goals.
  • 3.3 Identify and perform learning activities that address one’s gaps in knowledge, skills, and/or attitudes.
  • 3.4 Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.
  • 3.5 Incorporate feedback into daily practice.
  • 3.6 Locate, appraise, and assimilate evidence from scientific studies related to patients’ health problems.
  • 3.7 Use information technology to optimize learning.
  • 3.8 Participate in the education of patients, families, students, trainees, peers, and other health professionals.
  • 3.9 Obtain and utilize information about individual patients, populations of patients, or communities from which patients are drawn to improve care.
  • 3.10 Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes.

4. Interpersonal and Communication Skills

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

  • 4.1 Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.
  • 4.2 Communicate effectively with colleagues within one’s profession or specialty, other health professionals, and health related agencies (see also 7.3)
  • 4.3 Work effectively with others as a member or leader of a healthcare team or other professional group (see also 7.4)
  • 4.4 Act in a consultative role to other health professionals.
  • 4.5 Maintain comprehensive, timely, and legible medical records.
  • 4.6 Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics.
  • 4.7 Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions.

5. Professionalism

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

  • 5.1 Demonstrate compassion, integrity, and respect for others.
  • 5.2 Demonstrate responsiveness to patient needs that supersedes self-interest.
  • 5.3 Demonstrate respect for patient privacy and autonomy.
  • 5.4 Demonstrate accountability to patients, society, and the profession.
  • 5.5 Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.
  • 5.6 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.

6. Systems-Based Practice

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.

  • 6.1 Work effectively in various healthcare delivery settings and systems relevant to one’s clinical specialty.
  • 6.2 Coordinate patient care within the healthcare system relevant to one’s clinical specialty.
  • 6.3 Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care.
  • 6.4 Advocate for quality patient care and optimal patient care systems.
  • 6.5 Participate in identifying system errors and implementing potential systems solutions.
  • 6.6 Perform administrative and practice management responsibilities commensurate with one’s role, abilities, and qualifications.

7. Interprofessional Collaboration

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

  • 7.1 Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust.
  • 7.2 Use the knowledge of one’s own role and the roles of other health professionals to appropriately assess and address the healthcare needs of the patients and populations served.
  • 7.3 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.
  • 7.4 Participate in different team roles to establish, develop, and continuously enhance interprofessional teams to provide patient- and population-centered care that is safe, timely, efficient, effective, and equitable.

8. Personal and Professional Development

Demonstrate the qualities required to sustain lifelong personal and professional growth.

  • 8.1 Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors.
  • 8.2 Demonstrate healthy coping mechanisms to respond to stress.
  • 8.3 Manage conflict between personal and professional responsibilities.
  • 8.4 Practice flexibility and maturity in adjusting to change with the capacity to alter one’s behavior.
  • 8.5 Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients.
  • 8.6 Provide leadership skills that enhance team functioning, the learning and working environment, and/or the health care delivery system.
  • 8.7 Demonstrate self-confidence that puts patients, families, and members of the healthcare team at ease.
  • 8.8 Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty.

Entrustable Professional Activities (EPAs)

Achieving all of the competencies of the curriculum incorporates the demonstration of the 13 core behaviors and activities identified as “Core Entrustable Professional Activities for Entering Residency” (AAMC, 2014; accessed at https://www.mededportal.org/icollaborative/resource/887). The following 13 Entrustable Professional Activities (EPAs) are activities that our MD program graduates are able to perform without direct supervision (which is defined as a supervising physician being physically within the hospital or other site of patient care, and is immediately available to provide direct supervision) and regardless of specialty choice. Confirmation of all of these abilities and behaviors is a graduation requirement. Each EPA is mapped to specific competencies within the eight domains of the MD program curriculum (indicated in parentheses) that are critical to entrustment decisions. Each EPA is also predicated on the competencies of trustworthiness and self‑awareness of limitations that leads to appropriate help‑seeking behavior.

EPA 1: Gather a history and perform a physical examination.

  • Patient Care (1.2)
  • Knowledge for Practice (2.1)
  • Interpersonal and Communication Skills (4.1, 4.7)
  • Professionalism (5.1, 5.3, 5.5)

EPA 2: Develop a prioritized differential diagnosis and select a working diagnosis following a patient encounter.

Patient Care (1.2, 1.4)

  • Knowledge for Practice (2.2, 2.3, 2.4)
  • Practice-Based Learning and Improvement (3.1)
  • Interpersonal and Communication Skills (4.2)
  • Personal and Professional Development (8.8)

EPA 3: Recommend and interpret common diagnostic and screening tests.

  • Patient Care (1.4, 1.5, 1.7, 1.9)
  • Knowledge for Practice (2.1, 2.4)
  • Practice-Based Learning and Improvement (3.9)
  • Systems-Based Practice (6.3)

EPA 4: Enter and discuss patient orders/prescriptions.

  • Patient Care (1.2, 1.5, 1.6)
  • Knowledge for Practice
  • Practice-Based Learning and Improvement (3.1, 3.7)
  • Interpersonal and Communication Skills (4.1)
  • Systems-Based Practice (6.3)

EPA 5: Provide documentation of a clinical encounter in written or electronic format.

  • Patient Care (1.4, 1.6)
  • Interpersonal and Communication Skills (4.1, 4.2, 4.5)
  • Professionalism (5.4)
  • Systems-Based Practice (6.1)

EPA 6: Provide an oral presentation/summary of a patient encounter.

  • Patient Care (1.2)
  • Practice-Based Learning and Improvement (2.1)
  • Interpersonal and Communication Skills (3.1, 3.2)
  • Professionalism (4.1, 4.3)
  • Personal and Professional Development (8.4, 8.7)

EPA 7: Form clinical questions and retrieve evidence to advance patient care.

  • Knowledge for Practice (2.3, 2.4)
  • Practice-Based Learning and Improvement (3.1, 3.3, 3.6, 3.7, 3.9)
  • Interpersonal and Communication Skills (4.2)

EPA 8: Give or receive a patient handover to transition care responsibility to another healthcare provider or team.

  • Patient Care (1.8)
  • Practice-Based Learning and Improvement (3.5, 3.7)
  • Interpersonal and Communication Skills (4.2, 4.3)
  • Professionalism (5.3)

EPA 9: Participate as a contributing and integrated member of an interprofessional team.

  • Interpersonal and Communication Skills (4.2, 4.3, 4.7)
  • Professionalism (5.1)
  • Systems-Based Practice (6.2)
  • Interprofessional Collaboration (7.1, 7.2, 7.3)

EPA 10: Recognize a patient requiring urgent or emergent care, initiate evaluation and treatment, and seek help.

  • Patient Care (1.1, 1.2, 1.3, 1.4, 1.5, 1.6)
  • Interpersonal and Communication Skills (4.2, 4.6)

EPA 11: Obtain informed consent for tests and/or procedures that a beginning resident is expected to perform or order without supervision.

  • Patient Care (1.3, 1.6, 1.7)
  • Interpersonal and Communication Skills (4.1, 4.5, 4.7)
  • Systems-Based Practice (6.3)
  • Personal and Professional Development (8.7)

EPA 12: Perform general procedures of a physician.

  • Patient Care (1.1, 1.7)
  • Interpersonal and Communication Skills (4.5, 4.6)
  • Professionalism (5.6)
  • Systems-Based Practice (6.3)
  • Personal and Professional Development (8.7)

EPA 13: Identify system failures and contribute to a culture of safety and improvement.

  • Knowledge for Practice (2.1)
  • Practice-Based Learning and Improvement (3.4, 3.10)
  • Interpersonal and Communication Skills (4.2)
  • Professionalism (5.4)
  • Systems-Based Practice (6.4, 6.5)