Why physician competence should be top of mind, every day

Timothy M. Smith , Contributing News Writer

Physician competence is not an aspiration—it’s an expectation that is central to medicine. From an ethics perspective, it means much more than having technical medical knowledge and clinical skills. It also involves being self-aware and self-critical in day-to-day practice.

Ethics in Health Care

Explore the AMA Journal of Ethics for articles, podcasts and polls that focus on ethical issues that affect physicans, physicians-in-training and their patients.

An online continuing medical education module featured on the AMA Ed Hub™ explores competence through case studies of physicians at varying stages of their careers, identifying the skills that can be used to become critically self-aware and how to apply self-assessment and self-awareness strategies.

The AMA recently adopted ethical policy stating that individual doctors and physicians-in-training should strive to:

  • Cultivate continuous self-awareness and self-observation.
  • Recognize that different points of transition in professional life can make different demands on competence.
  • Take advantage of well-designed tools for self-assessment appropriate to their practice settings and patient populations.
  • Seek feedback from peers and others.
  • Be attentive to environmental and other factors that may compromise their ability to bring appropriate skills to the care of individual patients and act in the patient’s best interest.
  • Maintain their own health, in collaboration with a personal physician, in keeping with ethics guidance on physician health and wellness.
  • Intervene in a timely and appropriate manner when a colleague’s ability to practice safely is compromised by impairment, in keeping with ethics guidance on physician responsibilities to impaired colleagues.

“Competence is developmental and evolves over the professional life cycle,” the module says. “Maintenance of certification (MOC) and achieving other board certifications is essential, but it is not the whole of competence as an ethical responsibility for physicians. Physicians must also demonstrate situation-specific awareness of when they reach the boundaries of their knowledge and skills.”

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Physicians have duty to monitor their own competence

All physicians are susceptible to pitfalls in reasoning—such as relying unduly on heuristics and habits of perception, as well as succumbing to overconfidence—so being able to assess one’s own knowledge and skills is the essential starting point for developing and sustaining competence. This often involves participating in well-designed assessment programs and drawing on well-validated tools to continuously monitor one’s practice.

“One such strategy is to create a portfolio of materials for reflection in the form of written descriptions, audio or video recording, or other documentation of encounters with patients that can provide evidence of learning, achievement and accomplishment—or of opportunities to improve practice,” the module says. “A strength of portfolios as a tool for assessing one’s practice is that, unlike standardized examinations, they are drawn from one’s actual work and require self-reflection.”

But it’s been proven that physicians and trainees are better at assessing peers’ performance than their own, so achieving and sustaining competence ideally combines both self-assessment and candid, constructive feedback. High-quality external feedback comes from multiple sources and is specific, focusing on key elements of the ability being assessed. It also addresses behaviors, not personality traits. This reinforces strong behaviors and addresses deficiencies.

The module also explores self-awareness—being able to acknowledge the limitations of one’s knowledge and skills. All physicians and trainees must understand both that their clinical experience is limited and that they are not always aware of what they do not know.

“Competent physicians, regardless of their stage of practice, recognize in the moment those occasions when they are not best able to provide care in a given circumstance and seek appropriate assistance,” the module notes. “And they are able to use such moments as opportunities for learning.”

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External stressors are particular threats to a physician’s ability to provide care appropriately, and they can come from anywhere—even events outside of the clinical environment.

Hence, “the ability to monitor oneself in the moment is critical to physicians’ ethical responsibility to practice safely, at the top of their expertise but not beyond it,” the module says.

The CME module, “Cultivating Physician Competence Through Self-Assessment and Self-Awareness: Code of Medical Ethics,” is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™.

The module is part of the AMA Ed Hub, an online platform with high-quality CME and education that supports the professional development needs of physicians and other health professionals. With topics relevant to you, it also offers an easy, streamlined way to find, take, track and report educational activities.

Learn more about AMA CME accreditation.