Please begin this series at Part 1.
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.
As we entered the wards in our third year, something changed. The patient became the center of our professional world, and in turn the center of our competence. At least half of our grade was based on our performance in clinical settings and our ability to care for our patients.
The students who had excellent knowledge of their patients — those who most fully understood the patient story, who had best memorized and understood the results from diagnostic tests — stood out as exemplary. They were deemed competent by our supervising resident and attending physicians, a designation that meant more than high mark on any multiple choice test.
In the arena of medical education, competence is earned by consistently excelling in patient care and earning the notice, praise or promotion from supervising physicians. A classic instance of this is when an excellent resident is asked to become the chief resident within a residency program.
The program promotes a chief resident to this position because they are exemplary in their patient care and in their relationships with hospital staff, consultants, fellow residents and attending faculty. And there is great value in serving as a chief resident, of being the voice for your fellow residents, in collaborating with attending faculty and in creating a culture of learning and enrichment within the program. Having the opportunity to create value for the program makes serving as chief resident an honor and a privilege.
In the clinical context, patients will often speak volumes about a physician that they love — “Oh, he’s a great doctor,” or “She took care of my mother during a difficult time and she’s the best.” These sentiments can reverberate in a community and physicians deemed most competent by their patients can garner more patients and popularity.
How does this relate to competence? As explained above, performing at a high level — consistently excelling in patient care, continually learning from colleagues, supervisors, medical journals and patients themselves may lead to competence. Yet, for the medical student, clerk, or resident who is striving for competence, this prescription for success may not lead to the desired outcome. The task ahead is complicated by the fact that competence does not come from the self, but rather from the people around us — our patients, our colleagues, and our supervisors.
This dynamic is perhaps the most interesting aspect of competence in the medical field — a physician cannot claim competence for himself or herself, but must instead be given or regarded to have competence by colleagues, supervisors and patients.
This paradox can create a real tension in the mind of a young medical student or resident. A better question might be “What is a practical approach to becoming competent?” First, competence doesn’t happen overnight, which can be a hard realization. No one thing that you do will bring competence, but a long-term concerted effort will. Just as Malcolm Gladwell posits in his book Outliers, 10,000 hours of practice the right way will lead to expertise in the medical field.
What is the right way? Stay motivated, stay up to date, and stay positive. Continue to serve your patients to the best of your ability. By consistently engaging in the task of caring for your patients, much will be learned and experience gained. Learn from your mistakes. Surround yourself with colleagues that will take the time to teach you and learn with you.
This is why it is so important to carefully select a medical school, residency or fellowship program. It is not so much where you go as who you go with. I guarantee that you will learn more from the people that you surround yourself with than from the institution itself — your classmates, co-residents, core faculty and patients will teach you and fill you with knowledge and compassion.
The path to competence is not a linear one; it is full of trials and tribulations, mistakes and errors, frustration and self-doubt. However, it is only through these difficulties that the physician emerges fully competent. Without the struggle, competence will never be attained.
Ad astra, per aspera.
Please continue on to Part 3.