Questioning medical competence: Should the Covid-19 crisis affect the goals of medical education?

The COVID-19 pandemic has disrupted many societal institutions, including health care and education. Although the pandemic's impact was initially assumed to be temporary, there is growing conviction that medical education might change more permanently. The International Competency-based Medical Education (ICBME) collaborators, scholars devoted to improving physician training, deliberated how the pandemic raises questions about medical competence. We formulated 12 broad-reaching issues for discussion, grouped into micro-, meso-, and macro-level questions. At the individual micro level, we ask questions about adaptability, coping with uncertainty, and the value and limitations of clinical courage. At the institutional meso level, we question whether curricula could include more than core entrustable professional activities (EPAs) and focus on individualized, dynamic, and adaptable portfolios of EPAs that, at any moment, reflect current competence and preparedness for disasters. At the regulatory and societal macro level, should conditions for licensing be reconsidered? Should rules of liability be adapted to match the need for rapid redeployment? We do not propose a blueprint for the future of medical training but rather aim to provoke discussions needed to build a workforce that is competent to cope with future health care crises.

Medical Education in the United States and Canada, 2020.

For the third time this century, the Association of American Medical Colleges has coordinated a collection of reports from their member medical schools that collectively reflect the state of medical education in the United States and Canada. This introduction to the September 2020 supplement to Academic Medicine provides an overview of the collection, with 145 out of 171 eligible medical schools participating in the project. The authors observe trends and similarities across the reports from participating schools, structuring the introduction to mirror the main questions posed to the schools: highlights of each school's medical education program, curriculum description, curricular governance, education staff, faculty development and support in medical education, regional medical campuses, and initiatives in progress. Key findings from the authors include expansion of student enrichment tracks, early clinical encounters, focus on wellness, expansion in competency-based medical education, and continued evolution of approaches to assessment. The authors note that this supplement was produced before COVID-19, and although it robustly chronicles the prepandemic state of medical education, medical education has already evolved and will continue to do so. This view offers important opportunities to observe and study changes in the curricula.

The Change to Pass/Fail Scoring for Step 1 in the Context of COVID-19: Implications for the Transition to Residency Process.

In this Invited Commentary, the author considers the February 2020 announcement that scoring on the United States Medical Licensing Examination (USMLE) Step 1 will change to pass/fail no sooner than January 2022 and its effects on the transition to residency process in the context of both the recommendations of the Invitational Conference on USMLE Scoring (InCUS) held in March 2019 and the disruptions caused by the COVID-19 pandemic in the spring of 2020. The author suggests that the medical education community must embrace any positive changes that come about as a result of the pandemic while continuing to systematically review the strengths and areas for improvement in the current transition to residency process.In its recommendations, InCUS provided a thoughtful set of action priorities and an effective process to work together, which can inform and guide the work ahead. The COVID-19 pandemic is dominating the educational and clinical environments and is now the biggest disruptor in all aspects of life, not just medical education. It is the responsibility of leaders in medical education to have a vision for and then implement an improved continuum of education that maintains the core values of the field and fits the health care delivery needs of today and the future.