The Development of Medical Student Competence: Tracking Its Trajectory Over Time

Abstract

Introduction

Developmental theories recognize that there is a progression of competence over time. However, despite growing interest in the developmental trajectories of medical students, little research exists that longitudinally documents their gains across domains. Our goal was to track students’ perceived competence over time and to identify different patterns across competencies.

Method

At the end of each of their four academic years, four successive cohorts of Harvard Medical School (HMS) students were surveyed to indicate how much they had learned in each of 28 areas. Nineteen items mapped onto the six competency areas defined by the Accreditation Council for Graduate Medical Education (ACGME) and competency cluster scores were calculated for each.

Results

Medical knowledge, patient care, and systems-based practice increased significantly each year from the prior year’s baseline, with the other competencies demonstrating less consistent patterns of growth. At the end of year 1, interpersonal skills, problem-based learning and improvement, and professionalism were rated highest. By the end of year 4, interpersonal skills remained the most highly rated, and systems-based practice, which grew considerably from years 1 to 4, was still rated lowest.

Conclusions

Medical education results in a progressive trajectory of overall competence, with increases, some small and some large, found for every domain for every year. However, the six domains start from differing baselines and progress at different rates over students’ undergraduate careers.