Developing Clinical Competence

The development of clinical competence is the main purpose of medical education. The long road to become clinically competent starts on the first day of medical school, and every institution strives to select the best students. The responsibility of medical schools is to train those students to become clinically competent physicians who are highly qualified and specialized professionals able to function in a constantly changing society that puts continuously growing demands on the medical profession. Understanding clinical competence is therefore crucial not only for medical education, assessment, and licensing examinations, but also for society and its responsibility for the quality of health care. However, there is little consensus about what clinical competence is and how to measure it. A proper definition and a better understanding of clinical competence and its components would serve as a criterion for validating medical educational programs and would ! assure a minimum level of competency at the end of medical school and beyond during residency. Each of the previous chapters of this thesis highlights different aspects of clinical competence and its development. In the introductory chapter the lack of consistency in definitions of clinical competence is emphasized and a historical overview is given to shed light on the variety of definitions used over the last decades. The study presented in Chapter 2 explores the effect of level of pre-university performance on preclinical and clinical performance. The study in Chapter 3 addresses the impact of clinical training during clerkships on students’ learning. Specifically, the relationship among the nature and volume of patient encounters, quality of supervision, and the learning outcomes were explored. The study of Chapter 4 is directed at the interaction between knowledge and a problem-solving ability during students’ diagnostic problem solving at end-of-clerkship examinations. Chapter 5 focuses on clinical competence during clerkships and end-of-clerkship examinatio! ns. In this study we explored whether clinical teachers place different values on individual components of competence while students work on the wards or while students are examined during clerkship examinations. The study reported in Chapter 6 investigates how recall of case information changed for different expertise groups under different conditions, while research discussed in Chapter 7 was conducted to find out how the selection of case information by students and doctors during different stages of the diagnostic process is related to different expertise groups. In the present and final chapter of this thesis the main findings of all previous chapters are summarized and discussed. At the end of this chapter, conclusions and suggestions for further research are given.

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