Emergency Medicine: PD Post November/December 2017

Nov 16, 2017

Competency By Design 

Nazanin Meshkat Picture 2016.jpegJuly 2018 marks a landmark in the history of medical education as we launch Competence by Design in our Emergency Medicine program.


A few years back, on a shift like any other shift, I recall working with a PGY 1 resident who kept apologizing for not being “capable” of handling all the cases he’d seen that night. I found the expectation surprising…after all, how would a PGY1 manage “all cases”?

At the same time, the feeling was naggingly familiar.

Walking home, leaving behind the flurry of the shift, I remembered why. Rewind back to my time in medical school and residency, and I had experienced that same sentiment…Anytime I was not able to manage a case I was acutely aware of my limitations, and the failure felt crushing. The need to be excellent was overwhelming…and frankly crippling at times, stunting growth and a necessary process in my journey to learn. Intellectually, we all know that the road to competence is a long journey, bumpy, and with lots of ups and downs. Emotionally, there is a dissonance of a never-ending need for positive feedback, and a devastating emotional response to constructive feedback. This has led to a dysfunction – a dysfunction in our ability to give and receive feedback.

Competence by design is a crossroad in our trajectory as individuals, educators, programs, and clinicians. With more accurate, varied, and focused assessments, we have the opportunity to engage our learners in their learning and rewiring us not only to solicit and incorporate feedback but also to give feedback.

The experience so far with programs that have implemented Competence by Design, is that yes, the rewiring was hard at first…until the tipping point was reached. Join us on our climb to the tipping point. Below you will find some resources that will help in your journey.


Please take a moment to review the DOM's CBD website on our Program Specific CBD Website, Click the Drop-down for Emergency Medicine

In addition, we have our Visiting Professor, Dr. Watlings coming to talk about Feedback on December 6th

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