Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations

Abstract

Delineating the requisite competencies of a 21st-century physician is the first step in the paradigm shift to competency-based medical education. Over the past two decades, more than 150 lists of competencies have emerged. In a synthesis of these lists, the Physician Competency Reference Set (PCRS) provided a unifying framework of competencies that define the general physician. The PCRS is not context or population specific; however, competently caring for certain underrepresented populations or specific medical conditions can require more specific context. Previously developed competency lists describing care for these populations have been disconnected from an overarching competency framework, limiting their uptake. To address this gap, the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development adapted the PCRS by adding context- and content-specific qualifying statements to existing PCRS competencies to better meet the needs of diverse patient populations. This Article describes the committee’s process in developing these qualifiers of competence. To facilitate widespread adoption of the contextualized competencies in U.S. medical schools, the committee used an established competency framework to develop qualifiers of competence to improve the health of individuals who are lesbian, gay, bisexual, transgender; gender nonconforming; or born with differences in sexual development. This process can be applied to other underrepresented populations or medical conditions, ensuring that relevant topics are included in medical education and, ultimately, health care outcomes are improved for all patients inclusive of diversity, background, and ability.

Comprehensive Curriculum for Internal Medicine Residents on Primary Care of Patients Identifying as Lesbian, Gay, Bisexual, or Transgender

“…Content was selected based upon the AAMC competencies in caring for individuals with diverse sexual orientations and gender identities; these competencies set a national standard for medical education curriculum integration identities. 6,17 Although lack of faculty knowledge has been cited as an educational barrier, the curriculum was implemented by nonexpert faculty without additional preparation or research. Both residents and faculty felt that LGBT primary health care was important; however, consistent with prior research, residents and faculty had received little prior instruction on this topic.…”

Deaf and Hard-of-Hearing Learners in Emergency Medicine

“… 22 The same recommendations that guide hearing physicians also allow DHoH students to operate within a team and to provide excellent care to their patients. The addition of DHoH students in the ED may reduce common errors among all physicians through (1) a focus on accurate translation, 23 (2) patient care diversity awareness, 24 and (3) improved access to care through increased cultural competency in working with the DHoH population. 25…”

Transgender Medicine Curriculum: Integration Into an Organ System–Based Preclinical Program

“…Eckstrand, Potter, Bayer, and Englander proposed the use of qualifying statements to provide context to 20 of the 58 PCRS competencies. 6 For example, under the Patient Care domain, competency 1.2 (bold text) can be qualified (italicized text) as follows: Gather essential and accurate information about patients and their conditions through history taking, physical examination, and the use of laboratory data, imaging, and other tests by sensitively and effectively eliciting relevant information about sex anatomy, sex development, sexual behavior, sexual history, sexual orientation, sexual identity, and gender identity from all patients in a developmentally appropriate manner. 6,4 …”