EDITORIAL

Generic competencies, an unresolved issue in faculties of medicine

Competencias transversales, un tema pendiente en las facultades de medicina

Jordi Palés-Argullós and Maria Nolla-Domenjó

Fundación Educación Médica.
E-mail: jpales@ub.edu

Generic competencies - also known as core, key or cross-curricular competencies, depending on authors and contexts - are those that spill over from one discipline to be potentially developed within all the others. They are necessary to be able to practise any profession with efficacy, but they are not often considered explicitly within a particular subject, at least within the health sciences. The Tuning project classifies them in three categories as instrumental, interpersonal and systemic competencies [1]. According to van der Vleuten they include professionalism, reflection, leadership, teamwork and clinical reasoning [2]. Bioethics, communication, health economics, management, sociology, teaching competencies, etc. may also be taken into account.

A number of studies have established quite clearly that when problems arise in day-to-day practice, these competencies are very often involved [3] and success in the labour market is linked with such competencies [4]. Hence the need for these competencies to be taken into consideration in the curricula of medical schools and to ensure that they are acquired by our students and assessed.

As van der Vleuten said, these competencies represent complex behaviours. They therefore cannot be learnt by simply doing a course that lasts a couple of weeks and then sitting an exam. A student cannot be trained in communication in three weeks, be evaluated by means of a structured objective clinical assessment and be a good communicator. These competencies require a longitudinal development and follow-up throughout the whole programme of studies and they are acquired better within the framework of integrated curricula [2].

They can be taught in different ways, such as spreading them over several subjects in which they can be worked on (teamwork, problem-solving, decision-making) or in the form of specific subjects (communication, professionalism, bioethics, research). But, in any case, they must always be acquired as longitudinal tracks that run through the entire length of the degree course. There are also different strategies for teaching them, such as problem-based learning, mini-congresses held by students, group work activities, carrying out research assignments, activities fostering reflection, role-playing, and so forth.

Another fundamental aspect is the assessment of such competencies. There are instruments for assessing competencies, such as the mini-CEX, P-Mex (for professionalism), 360^o assessment, peer assessment, portfolios, etc., which have proved to be both valid and reliable. Yet, they are not instruments that are simple to use and require previous training of the assessor, that is to say, the lecturers in the faculties.

The importance of these competencies is such that, recently, within the framework of the Conference of the Association for Medical Education in Europe (AMEE) held in Barcelona, the Spanish Medical Education Society (SEDEM) organised a symposium on this subject. Some of the most important topics addressed there were clinical reasoning, medical professionalism and bioethics. Likewise, within the framework of the Public Health Summer School in Maó (Menorca), the SEDEM held another meeting about neglected competencies in medical education, where issues addressed included competencies related to health economics, research, health promotion, clinical management, professional values, tutoring and clinical reasoning. We hope to be able to publish a summary of the conclusions reached in a forthcoming issue of the Journal.

We can therefore state that the topic of generic competencies is back on the table, but nevertheless, although nearly all Spanish faculties of medicine have taken them into account in their curricula - at least formally - few of them actually work on and assess them in a systematic manner. We would like to take this opportunity to ask faculties of medicine to reconsider these aspects and to take the steps needed to ensure these competencies are both acquired and assessed.

References

1. Baños JE, Pérez J. Cómo fomentar las competencias transversales en los estudios de ciencias de la salud: una propuesta de actividades. Educ Med 2005; 8: 216-25.         [ Links ]

2. Van der Vleuten C. Competency-based education is beneficial for professional development. Perspect Med Educ 2015; 4: 323-5.         [ Links ]

3. Papadakis MA, Teherani A, Banach MA. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med 2005; 353: 2673-82.         [ Links ]

4. Meng C. Discipline-specific or academic? Acquisition, role and value of higher education competencies (PhD dissertation). Maastricht: University of Maastricht; 2006.         [ Links ]