Attributes of Lifelong Competence in Medical Practice

Abstract

Consideration of the characteristics associated with lifelong competence raises an ancient dispute about the relative influences of nature and nurture—of inheritance and environment. The process of selecting students for admission to medical school is concerned with nature. The medical curriculum and hospital training programs represent an extreme form of nurture or environment influence. What do we know about the relative contribution of these two factors to competence? Although the production of competent physicians is a major goal of the medical educational process, surprisingly few attempts have been made to determine how well this goal is achieved. The large volume of research on selection of medical students almost suggests that picking students who can complete the four-year curriculum is a goal in itself. The medical students are accessible and easily studied whereas the competence of the physicians —the medical-school output—is difficult or occasionally impossible to measure. We do, however, have a