General Medical Competencies

Block I Faculty of Medicine University of Sriwijaya

Introduction

Competence is a standardized requirement for an individual to properly perform a specific job. Competence is the state or quality of being adequately or well qualified, having the ability to perform a specific role. Competency is a combination of

knowledge, skills and behavior utilized to improve performance.

Level of General Competence

Dreyfus and Dreyfus has introduced the levels of competence in competence development. The levels are:

Novice: Rule based behavior, strongly limited and inflexible Experienced Beginner: Incorporates aspects of the situation Practitioner: Acting consciously from long term goals and plans Knowledgeable practitioner: Sees the situation as a whole and acts from personal conviction Expert: Has an intuitive understanding of the situation and zooms in on the central aspects Virtuoso: Has a higher degree of competence, advances the standards and has an easy and creative way of doing things Maestro: Changes the history in a field by inventing and introducing radical innovations

Level of General Competence (contd)

The process of competence development is a lifelong series of doing and reflecting. It requires a special environment, where the rules are necessary in order to introduce novices, but people at a more advanced level of competence will systematically break the rules if the situations requires it. This environment is synonymously described using terms such as learning organization, knowledge creation, self organizing and empowerment.

General Competence

In a specific organization or community you need to have the Professional Competence of the profession. The professional competencies are equal to the Occupational competencies. For all organizations and communities there is a set of primary tasks that competent people have to contribute to all the time.

General Competence

The four general competences are:

Meaning Competence: Identifying with the purpose of the organization or community and acting from the preferred future in accordance with the values of the organization or community. Relation Competence: Creating and nurturing connections to the stakeholders of the primary tasks. Learning Competence: Creating and looking for situations that make it possible to experiment with the set of solutions that make it possible to solve the primary tasks and reflect on the experience. Change Competence: Acting in new ways when it will promote the purpose of the organization or community and make the preferred future come to life.

Four stages of competence

Relate to the psychological states involved in the process of progressing from incompetence to competence in a skill: 1. Unconscious incompetence

The individual neither understands or knows how to do something, nor recognizes the deficit or has a desire to address it. Though the individual does not understand or know how to do something, he or she does recognize the deficit, without yet addressing it. The individual understands or knows how to do something. However, demonstrating the skill or knowledge requires a great deal of consciousness or concentration. The individual has had so much practice with a skill that it becomes "second nature" and can be performed easily (often without concentrating too deeply). He or she can also teach it to others.

2.

Conscious incompetence

3.

Conscious competence

4.

Unconscious competence

Medical Profession Competencies

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2.
3. 4. 5. 6. 7.

Medical Knowledge Patient Care Professionalism Interpersonal and Communication Skills Medical Informatics Population Health and Preventive Medicine Practice-Based and Systems-Based Medical Care

1. Medical Knowledge

Medical doctor must demonstrate as

measured by internal and national-based examinations and skills assessments that they have a firm grasp of the clinical sciences and the basic sciences that underpin medicine; and as well the ability to apply that knowledge appropriately in the clinical setting.

1. Medical Knowledge (contd)

Medical doctor are expected to: 1. Demonstrate a working knowledge of the basic and clinical sciences 2. Demonstrate proficient clinical skills in the taking of a patient history and in carrying out a physical examination 3. Demonstrate an analytic thinking approach to clinical situations 4. Demonstrate cultural competence in dealing with patients and their families

2. Patient Care

Medical doctor must be able to provide supervised patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

2. Patient Care (contd)

Medical doctor are expected to: Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families Gather essential and accurate information about their patients Develop patient treatment and management plans Counsel and educate patients and their families Perform competently those medical procedures considered essential for their education Provide health care services aimed at preventing health problems or maintaining health Work with health care professionals, including those from other disciplines, to provide patient-focused care

3. Professionalism

Medical doctor must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

3. Professionalism (contd)
Medical doctor are expected to: Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and ongoing professional development Demonstrate a commitment to ethical principles pertaining to the provision of clinical care, confidentiality of patient information, and informed consent Demonstrate sensitivity and responsiveness to patients culture, age, sexual orientation, gender, and disabilities Dress in a manner consistent with that of a medical professional

4. Interpersonal and Communication Skills

Medical doctor must demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

4. Interpersonal and Communication Skills (contd)

Medical doctor are expected to: Create a therapeutically and ethically sound interaction with patients Use effective verbal and non-verbal listening skills to elicit appropriate information and communicate effectively in writing Work effectively with others as a member of a health care team Effectively communicate with a patients family and other health care professionals

5. Medical Informatics
Medical doctor must be able to efficiently consult the scientific literature as a means of optimizing patient care. Medical doctor are expected to: 1. Carry out computerized medical literature searches as a means of leaning about patients diseases, and the most sound and proven effective therapeutic interventions grounded in evidence based medicine 2. Determine what information is usable based on various patient findings

5. Medical Informatics (contd)

Medical doctor are expected to: 3. Convey their findings in a coherent manner to their attending physicians and residents 4. Use information technology to manage information and support their own education 5. Stay current with the latest information technology as it relates to medicine 6. Develop life-long learning skills

6. Population Health and Preventive Medicine

Medical doctor must be cognizant of the association between the health of their patients and that of the population at large and this understanding must be grounded in a solid knowledge base and appreciation of the principles of disease prevention.

6. Population Health and Preventive Medicine (contd)

Medical doctor are expected to 1. Understand the importance of preventive medicine in disease avoidance and convey to their patients the central importance of prevention as a preference to treatment of disease 2. Extrapolate the disease findings of their patients with disease prevalence locally and nationally 3. Understand the impact of complementary and alternative medical practices on their patients 4. Understand and importance of diet and exercise on disease prevention and health maintenance and be able to take a nutrition history of their patients

Practice-Based and Systems-Based Medical Care

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2.

3.

4.

5.

Medical doctor must demonstrate an awareness of the larger context and system of health care. Medical doctor are expected to: Obtain and use information about their own population of patients and the larger population from which their patients are drawn Understand how patient care practices impact on the larger society and how elements of the larger system may impact on their future practice Participate in the education of their patients regarding their health care Know how types of medical practice and delivery systems differ from one another Understand the importance of providing cost effective health care that does not compromise quality