title: Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States.
abstract: OBJECTIVE
  There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity.
  
  
  METHODS
  Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes.
  
  
  RESULTS
  Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency.
  
  
  CONCLUSIONS
  Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.
authors: University of Florida College of Medicine, Gainesville FL, USA.
authors: Catherine
authors: 0000-0003-1957-1543
authors: C
authors: Gonsalves
authors: Department of Medicine, University of Florida College of Medicine, Gainesville FL, USA.
authors: Zareen
authors: 0000-0003-4328-5766
authors: Z
authors: Zaidi
mesh_terms: D001290:Attitude; D002983:Clinical Competence; D003162:Competency-Based Education; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004645:Empathy; D006801:Humans; D019359:Knowledge; D005791:Patient Care; D010819:Physician's Role; D010820:Physicians; D000068616:Professionalism; D036301:Qualitative Research; D012649:Self Concept; D013337:Students, Medical; D014481:United States
keywords: Competency-based education; Medical Students; Perception; Physicians; United States