Medical students and other learners who take the time to examine core competencies, perhaps hoping to find direction on what they’re expected to master, may come away frustrated. Experts say that’s for an excellent reason: The competencies weren’t created for them to use.
“When we build competencies, typically we do that for the people who are educating,” said Seneca Harberger, MD, a family physician and a clinical informatics fellow at the Danville, Pennsylvania-based Geisinger integrated health system. “A problem happens when we go to make materials and we don't acknowledge that these competencies or objectives weren't really built with a learner in mind. And then we expect a learner to automatically use these things that maybe aren't really designed for them.”
To deal with that concern in clinical informatics fellowship training, Geisinger physicians built and then applied a set of user-focused competencies in clinical informatics. Dr. Harberger discussed the project along with Bruce Levy, MD, a pathologist and director of Geisinger’s clinical informatics fellowship program, at the AMA ChangeMedEd® 2025 national conference in Chicago.
Geisinger is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Keeping the learner front of mind
At Geisinger, the project looked at how the Accreditation Council for Graduate Medical Education (ACGME) has core competencies that are meaningful to instructors but can be less helpful for learners.
For example, “in primary care, one of the subcompetencies from the ACGME for family medicine is that as a resident, I should get good at managing chronic illness,” Harberger said. “If I'm an expert at managing chronic illness, I know what that means to say somebody should get good at that. You can give me a rubric, and I can make a broad estimation. But if I were trying as a learner to figure out what is involved in achieving that subcompetency, I wouldn't really have any way to do that. Or if I did, I'd probably be misguiding myself because there's not enough information about what to do.”
Geisinger physicians began by tackling ACGME’s six core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, systems-based practice, and professionalism. Then they considered helpful textbooks, courses, experts and other resources to broaden that to a comprehensive, specific list of 96 topics related to clinical informatics training learners might need to master. The next step? Making that list manageable for them to tackle.
“Now we're faced with this other issue, which is, if you're a learner and you come across a list of 96 things you're supposed to learn, it's overwhelming,” he said. “The next step is how do we take that list and then make it rightsized and organized?”
This step involved setting up different categories of resources and determining which areas of instruction those resources would support. Geisinger created 14 domains matched to areas of potential interest, labeled by modality, intensity and availability. At the end of the project, there was a self-guided curriculum that learners could use to prepare themselves and master the core competencies.
From AI implementation to digital health adoption and EHR usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors.
Along these lines, the AMA launched its Center for Digital Health and AI in October. The AMA center will address four key areas that are pivotal to the long-term success of these technologies:
- Policy and regulatory leadership—working with regulators, policymakers and technology leaders to shape benchmarks for safe and effective use of AI in medicine and digital health tools.
- Clinical workflow integration—creating opportunities for physicians to shape AI and digital tools so they work within clinical workflows and enhance patient and clinician experience.
- Education and training—equipping physicians and health systems with knowledge and tools to integrate AI efficiently and effectively into practice.
- Collaboration—building partnerships across the tech, research, government and health care sectors to drive innovation aligned with patient needs.
Finding the best way to teach
The project was, in many ways, a natural fit, said Dr. Harberger, adding that “we were well-positioned for a couple of reasons to tackle this problem for novice informaticists.”
Not only is clinical informatics a newer specialty, but the field itself has done recent work examining its specialty-specific core competencies.
“Informatics can be pretty self-driven,” he said. “A lot of the knowledge and skills I pursue as I’m learning it can be things I practice on my own.”
But similar projects can be useful outside of the field of clinical informatics, Dr. Harberger said, being beneficial in many ways.
“The process, whatever time intensity it had, forced me to consider how we thought about what was useful,” he noted. Older assumptions about what should be taught fall away. “I think we often make the mistake of focusing on simplicity. Going through this process and expanding all the details allows you to recognize, OK, there is subtlety here. It's not just about: How can we do this efficiently? As learners and educators, there is a value in doing an in-depth consideration of what's involved in our specialties.”
Explore other highlights from AMA ChangeMedEd® 2025, along with session slides, visual notetaking, and more.
