What the heck, let’s talk about the core competencies. But first let’s talk about my new pedometer. My first official reading from today (which was fairly busy in hospital as Tuesdays go) is below:
I show the number of steps because that’s more impressive. Honestly it works out to a little over a mile and a half. It doesn’t count stairs, which gripes me because I pride myself on climbing 8 flights on any given day.
Ok, so I cheat a little. I go up about 4 or 5 flights, then walk on the level to the next set of stairs–to catch my breath. I’ll let you in on a secret. When I put it in my satchel, I can add over a thousand steps just swinging the bag. But I don’t do that.
I’m not sure what competency that belongs under. I think it’s the bamboozle competency.
The Official Core Competencies:
Medical Knowledge and Patient Care: I generally put these two together as a closely related set. This is best exemplified by my colleague, Dr. Bill Yates, MD, on his blog, Brain Posts. The more reliable, current, and accessible the knowledge source, the better patient care a doctor can deliver–provided he or she knows how to apply the knowledge. You can get medical knowledge from open access literature, as long as you’re alert to the reality that there are some predatory publishers out there. So check with Jeff Beall.
Systems-Based Practice: There are systems within systems. I generally don’t stop at just teaching trainees about our hospital system. I think they need to know about how the medical boards and government influence the way doctors practice. Maintenance of Certification (MOC) exerts a significant braking effect on the pursuit of creativity and excellence in medicine. I’m not shy about sharing that opinion.
Practice-Based Learning: This is closely allied to the health care system. There is more than one way to skin a cat and I believe that physicians should be able to figure out for themselves how best to use the learning resources out there in the service of lifelong learning. I think my Clinical Problems in Consultation Psychiatry (CPCP) case-based learning is better than just about anything I can find on the American Board of Psychiatry and Neurology (ABPN) web site when we consider the Performance in Practice (PIP) modules–which should be made optional. Active participation in reflective self-improvement is a habit…the one Stephen Covey called “sharpening the saw.”
Interpersonal Skills and Communication: Daily I’m challenged in my role as psychiatric consultant to communicate clearly with my colleagues, nurses, and other patient care professionals about the safest and most effective way to help patients heal. It’s more about listening.
Professionalism: This is the hardest to define and it has been done in terms of qualities of the physicians and by specific behaviors. Not only must we do the thing right, we must do the right thing. It’s more than protecting the profession; it’s about protecting the patient, respecting colleagues and yourself, and cultivating a culture of integrity.
As a teacher I think it’s vital to guide and to learn from the next generation of doctors, to be humble and accept my flaws as well as my strengths…to realize the core competencies are a point of departure, not the whole journey.