Foundational Competencies for Undergraduate Medical Education

In recognition of the need to improve the undergraduate medical education (UME) to graduate medical education (GME) transition, the Coalition for Physician Accountability endorsed a core competency framework for all physicians and in 2014 proposed a unifying framework across training that contains six general but essential domains of competence. To maintain consistency across the continuum of training from UME to GME, the three sponsoring organizations (all members of the Coalition for Physician Accountability) have committed to utilizing the six core competency framework.

“An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes.” Source: Frank, JR., Snell, L., ten Cate, O., Holmboe, ES., Carraccio, C., Swing, SR., et al. (2010). Competency-based medical education: theory to practice. Medical Teacher; 32(8):638-645.

Medicine is a diverse field and training differentiates at various steps across the continuum. The purpose of the foundational competencies will be to describe the behavioral outcomes expected for all graduates of U.S. medical schools before they enter specialty-based GME. Importantly, these competencies may not address the entirety of what is necessary for a graduate who pursues training in a particular specialty. Therefore, the foundational competencies will be designed to represent the outcomes of all graduates inclusive of both DO and MD degree-granting schools, regardless of their post-medical school graduation trajectories or specialty choices.

The Liaison Committee on Medical Education (LCME®) is recognized by the U.S. Department of Education to serve as the accreditation body for US medical school programs awarding the MD degree. The AAMC and the American Medical Association co-sponsor the LCME accrediting authority; neither sponsor has a role in setting accreditation standards or requirements, making accreditation decisions, or designing and implementing accreditation processes. Although the LCME accepts and considers input from others, it makes decisions about accreditation standards independently. Thus, the LCME will be informed of, but not directly involved in, this work, and adoption of the resulting competencies will not be a specific requirement for accreditation.

The Commission on Osteopathic College Accreditation (COCA) of the American Osteopathic Association (AOA) is recognized by the U.S. Department of Education as the accreditor of colleges of osteopathic medicine. COCA accreditation signifies that a college has met or exceeded the commission's standards for educational quality. COCA will be informed of the work of revising the competencies.

During an earlier phase of this project, we explored how educators conceive of and operationalize competency-based education (CBE) for UME. We recognize that substantial work has been dedicated to CBE research, development, implementation, and assessment in both the MD and DO communities. We are not starting from scratch and are building upon and being informed by this literature and these lessons. Even before we started this project, we recognized that the PCRS and the Core EPAs are in need of updating. Instead of revising those CBE resources, we chose to first define what is foundational to UME. A solid base of foundational competencies will allow for a future set of Core EPAs or learning objectives for UME.

The foundational competencies will be organized by the six core competency framework widely endorsed in 2014 by the Coalition for Physician Accountability. Competency is defined as an “observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes.” Since competencies are observable, they can be measured and assessed to ensure their acquisition. These assessments may take multiple forms and methods of assessment may not be currently available. The existence or lack of available assessment methods should NOT limit the development of competencies. In other words, competencies should drive assessment and not vice versa. An Entrustable Professional Activity (EPA) is defined as an “essential task of a discipline that a learner can be trusted to perform with limited supervision in a given context and regulatory requirements, once sufficient competence has been demonstrated.” As a result of this project, existing EPAs will be refined and/or new EPAs will be developed once the competencies are complete.

The foundational competencies are being defined to create a common framework for competency-based education in UME. Use cases include curriculum and programmatic assessment design. Ultimately, the ways in which medical schools utilize these foundational competencies will be determined by the schools themselves. This project is not designed to be a mandate, but rather to provide an important tool for furthering competency-based medical education.

The foundational competencies will represent expected outcomes in six broad areas that were widely endorsed across the field in 2014 (Professionalism, Patient Care and Procedural Skills, Medical Knowledge, Practice Based Learning and Improvement, Interpersonal and Communication Skills, and Systems Based Practice). These will be intended to represent minimum competencies for all medical students, regardless of degree type or eventual specialty of practice. Other competencies, such as those in the “New and Emerging Competencies Series” are intended to add depth to key emerging thematic areas and guide curricular and professional development, especially in areas that are under-represented in the educational program. Both thematic and foundational competencies are intended to guide formative performance assessment, cross-continuum collaborations, and, ultimately, improvements in health care services and outcomes.