Measuring Competency as a Clinical Teacher By Elizabeth Herrle, MD

What does it mean to be competent?

  • Competence is a global assessment of an individual’s abilities as they relate to that individual’s current responsibilities. To be competent is “to possess all the required abilities in all domains in a defined context at a particular stage in clinical training”1.

How does competence relate to measuring competency?

  • Competencies are the building blocks of competence. While competence is a global assessment of multiple abilities, a competency is a discrete and observable ability of a learner.
  • A learner who is not yet competent may have achieved competency to perform many advanced tasks within their role.
  • A competency is a discrete evaluation and not a measure of a learner’s overall standing in relation to peers. (For example: the standard of competency for a first year medical student independently placing a central line is the same as for a third year resident, but we do not expect that a first year medical student will achieve this standard.)
  • Competencies can be measured in a variety of ways including exams, direct observations (in both simulated and clinical environments), 360-degree evaluations, global rating forms, and resident portfolios, though limitations exist to all these techniques.2

What are some tips for measuring competency through direct observation in clinical environments?

  • Familiarize yourself with the competencies that are relevant to your learners based on their specialty and level of training.
  • When possible, use checklists and standardized evaluations to assess competency.
  • Make it clear to the learner (and yourself) what competency you are assessing. “I’m going to observe your ability to lead this family meeting in a professional and compassionate manner.”
  • Provide direct feedback as soon as possible after evaluating a learner’s competency, and clearly delineate to the learner what aspects of their performance can be improved in order to reach the competency standard for the observed activity.
  • If able, follow-up after feedback to re-assess competency for that particular ability.
  • Encourage other members of your team to provide input on your learner’s competency.
  • After assessing a competency, provide written feedback to the learner’s clerkship or program director – cumulative assessments of competency are how they assess overall competence.

1 Frank JR, et al. Competency-based medical education: Theory to practice. Medical Teacher. 2010;(32): 638–645.

2 Lurie SJ, et al. Measurement of the general competencies of the accreditation council for graduate medical education: a systematic review. Academic Medicine. 2009;84(3):301-9.

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