Love Lifelong Learning: Eat Core Competency Pizza

I was hunting in the fridge for a snack and got an inspiration about making a Core Competency Pizza, which you could call a “half-baked” notion. Har!

Core Competency Pizza

Core Competency Pizza

The reason for this is that I’m rarely hungry for only one or two slices of pizza and the Core Competencies are usually best thought of as skills deployed in an integrated way rather than as idealized concepts considered separately.

It occurred to me that a case example might be the best way to illustrate this and I thought of the fictional ethics case I saw in a recent issue of Psychiatric Times [1]. The case summary is below:

Case summary

Mrs N is a 65-year-old retired nurse who, driven by seemingly intractable nausea and vomiting, decides to kill herself with an overdose of fentanyl she has stockpiled. She informs her ex-husband, who is also her power of attorney (POA), of her plans and asks that once she is dead he come to her house and take care of her affairs. Unfortunately, her ex-husband arrives while she is still alive and calls 911. When brought to the ED, Mrs N refuses all medical intervention and both she and her ex-husband angrily plead with staff to allow her to die, leading the staff to request an emergency ethics consultation.

– See more at: (registration is free to see the whole article).

Because Dr. Geppert already offers expert commentary on the ethical features of the case and this arguably pertains to the Professionalism competency, you could move on to imagine the case in light of the interplay of the other competencies.

Medical Knowledge and Patient Care are important for symptom management in view of the patient’s diagnosis. How would pain and nausea management be altered by a change in the story, such as whether or not the patient had a history of substance abuse?

Interpersonal and Communication Skills is a vital factor given the different stakeholders involved including the patient’s ex-husband and other specialists involved such as the oncologist and the consulting psychiatrist.

Systems-based Care is crucial. Consider how your hospital would address the issue of whether the patient would be admitted to the general hospital or a medical-psychiatry unit–if you have such a resource.

This blog featured a recently Clinical Problems in Consultation Psychiatry (CPCP) presentation on the right to die issue, thanks to resident psychiatrist, Dr. Emily Morse. As a quick review, the slides are below (click on a slide to enter the presentation):

And the CPCP is a great segue to the Practice-based Learning competency because it’s vastly superior to the Maintenance of Certification (MOC) process and promotes genuine reflection on how one would change one’s practice in light of examining the medical literature. Most doctors love lifelong learning. The MOC just frustrates physicians and raises the overall cost of health care:

This makes me hungry. Are you hungry?


1. Geppert, C., MD (2015) A Rational Suicide? Case Consultation and Quiz Commentary. Psychiatric Times  URL: Date Accessed: August 2, 2015

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