Reflecting On The Core Competencies

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:

Psychosomatic Medicine: Little BookMedical 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.



Decisional CapacitySystems-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.



7 Habits Stephen CoveyPractice-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.”


Telephone timeInterpersonal 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.




The Feather in My Cap
The Feather in My Cap

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.

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2 thoughts on “Reflecting On The Core Competencies

  1. Hi Dr. Amos,

    I am visiting Iowa this week, and came across an interesting article in the Des Moines Register today that may be of interest to you.
    Check out the Des Moines Register Opinion Page, Sunday June 14, 2015 (it is available on line).
    “State is warned: Act on licensing boards. Supreme Court ruling, attorney general’s letter is clear: Boards could face complaints of antitrust violations”. This article concerns the ruling issued by the U.S. Supreme Court in February 2015 against the North Carolina dental licensing board. It apparently applies to all professional state licensing boards. States cannot give a group of industry insiders the authority to regulate their peers, provide no oversight and consider members exempt from federal antitrust laws. They are not exempt and can be held responsible for violations. I query whether this Supreme Court ruling can be applied against the Maintenance of Licensure movement, the ABMS MOC programs, and their collusion with health care insurance companies, employers and hospitals? Go to for more details that also includes a copy of a letter from the State of Iowa Department of Justice regarding this matter.


    1. This is interesting. While I don’t know what impact the U.S. Supreme Court decision will have on Iowa directly, I will share communication from one of the Iowa Board of Medicine attorneys regarding MOC and MOL in Iowa:

      “Iowa does not require board certification for medical licensure. However, ABMS or AOA board certification is a requirement of the expedited licensure process.

      Currently, the Board’s rules recognize ABMS and AOA board certification.

      A licensee may list up to three specialties and board certification is not required to list such specialties.

      The Board’s rules do not prohibit the use of alternative board certification as long as it is not false or misleading.

      The Board has reviewed Maintenance of Certification (MOC) and Maintenance of Licensure (MOL) and has chosen not to pursue such programs at this time.”

      Note the “alternative board certification” comment which is relevant to the newly formed National Board of Physicians and Surgeons (NBPAS).


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