Medical competence as a multilayered construct

Background: The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for ‘fixed standards’ with ‘flexible pathways’, recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment. The model: Three layers are elaborated. This first is a core layer of canonical knowledge and skill, ‘that, which every professional should possess’, independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's ‘self-actualisation’, may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different. Implications: The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded

Medical student curiosity and medical education: A descriptive study

It has been suggested that intellectual curiosity is important to the practice of medicine and to medical student learning. It has also been proposed that medical education may suppress rather than promote the curiosity of medical learners. Despite these claims, curiosity has not been empirically investigated in medical education. The purpose of this study was to explore the concept of curiosity, as it is manifested in medical students across undergraduate medical education. A cross-sectional design was employed in which medical students, in all four years of undergraduate training, completed the Melbourne Curiosity Inventory (MCI) as a measure of their state-trait epistemic (i.e., intellectual) curiosity. The psychometric properties of the MCI were monitored to ensure validity of use in this study context. State and trait epistemic curiosity were described, and a repeated measures ANOVA was used to compare students across year of training. The state-trait curiosity construct was found to be valid in this study context, and was reliably measured by the MCI. Four hundred and two out of 751 students completed the inventory (53.5%). Trait curiosity was significantly higher than state curiosity overall (M = 64.5, SD = 8.5 vs. M = 58.5, SD = 11.6, respectively) and within each year of training. Moreover, state curiosity was found to be particularly low in the sample of year-2 students. This study is the first to empirically investigate intellectual curiosity in medical education. The findings suggest the possibility that medical education may be suppressing rather than promoting the curiosity of medical students.La curiosité intellectuelle est considérée importante dans le contexte de l'apprentissage et de la pratique médicale. Il a toutefois été suggéré que l'éducation médicale la réprimerait. Ces thèses n'ont toutefois jamais été évaluées. Le but de notre étude était d'explorer le concept de la curiosité tel qu'il est vécu par les étudiants en médecine de différents niveaux. Une analyse transversale d'étudiants en médecine provenant de quatre cohortes différentes fut utilisée pour évaluer leur état et leur trait de caractère de curiosité à l'aide du Melbourne Curiosity Inventory (MCI). Les propriétés psychométriques du MCI furent évaluées pour garantir sa validité et sa fiabilité dans notre contexte. Leur état et leur trait de caractère de curiosité ont été décrits et des mesures ANOVA répétées furent utilisées pour comparer les étudiants des différentes années de formation. Nous avons confirmé que nos mesures provenant du MCI de leur état et leur trait de caractère de curiosité demeuraient valides et fiables dans notre contexte. 402 des 751 étudiants ont complété le MCI. Le trait de caractère de la curiosité était significativement plus présent que l'état de curiosité (M = 64.5, SD = 8.5 vs. M = 58.5, SD = 11.6) et ceci se maintenait à travers les niveaux de formation. L'état de curiosité était particulièrement faible dans notre échantillon d'étudiants en 2e année. Notre étude est la première à mesurer la curiosité intellectuelle dans le contexte de l'éducation médicale. Elle présente les premières preuves supportant la thèse que l'éducation médicale pourrait réprimer la curiosité des étudiants en médecine