A competency is a statement of an expected outcome. The term comes from our collective desire to graduate
students who are ‘competent’ to move on to the next level of their training. IUSM has chosen to define further
what ‘competent’ means. During an extended process of curricular review and reform that covered a period of
about five years, the faculty, with input from medical students, adopted a definition of ‘competent’ that
recognizes defined outcomes in nine areas. These have become our nine ‘competencies.’
The great majority of participants involved in the curriculum review process agreed that the definition
of competency as embodied in the nine competencies is reasonable and desirable. Furthermore, they generally
agreed that our traditional curriculum has long addressed all nine of these elements to various degrees.
However, whereas we have done a thorough job documenting our students’ achievement in the ‘knowledge’ arena,
we have not done such a thorough job documenting our successes, and theirs, in many of the other ‘competencies.’
By stating that we, as a faculty, hold these nine competencies as the primary outcome goals for our graduates,
we have committed to documenting that we are achieving these goals and, to the extent that we are not
achieving them, that we will endeavor to revise the curriculum to achieve them.
A statewide competency director has been charged to oversee each competency. These faculty members must
ensure that the curriculum fosters achievement of their competencies, that students’ abilities are evaluated,
and, ultimately, that each student has achieved competence in a given area of study. In the same way that
course, clerkship, and elective directors assign a grade to students for routine coursework, the competency
directors decide whether each student has satisfactorily achieved level 1, 2, and 3 competency for the
competency that he or she manages.
At the regional campuses, Center Directors are ultimately responsible for the competencies, but this
responsibility has been delegated to campus competency directors. At some campuses, one individual handles
this responsibility, while at others multiple faculty members manage it.
Students must demonstrate abilities in each of the nine competency areas. Requirements acknowledge
progression of education from largely classroom and laboratory activities to engagement in patient care
activities at increasing levels of complexity and responsibility. During the first two years of school,
students must demonstrate proficiency at a beginner level (Level 1) and, by end of third year, at an
intermediate level (Level 2) for all nine competencies. In addition, by graduation all students must
also demonstrate advanced proficiency (Level 3) for three of the nine competencies.
Unless the student’s overall progress is so poor that the Student Promotions Committee recommends
dismissal, each statewide Competency Director can arrange remediation activities. To date, several students
have undergone remediation for failure to achieve or make satisfactory progress in competencies. As noted,
these are individualized to assist students in areas identified by faculty as needing attention. Examples
of remediation activities might include personal tutoring, shadowing physicians and then being critiqued by
them, discussions with a neutral third party regarding interpersonal conflicts, continuous monitoring of
students showing problems with substance abuse, etc.