In medical school, competence was defined by studying the course pack, that stack of crucial lecture notes, and memorizing the details therein. Especially in the first two years, my classmates and I spent virtually all of our waking hours reading text books, attending lectures, highlighting and underlining every word of the course material because we were told that all of it, every word, was important. This understanding of competence reflected the clear but unspoken end game: to have the best score on the exam possible, or at least a better score than the other half of the class.