Summary: Medical Education and
the Tyranny of Competency
ABSTRACT Those who educate medical students and physicians work in a world
suffused with the concept of competency.This article examines the intellectual origins
and hidden assumptions of this concept and argues that it is an inadequate, and even
harmful, concept to use as a guiding motif for professional education.The competency
model--which tends to be top-down and prescriptive--does not provide the frame-
work for objective educational assessment that it claims to provide. The alternative
apprenticeship model is more appropriate for professional education and is more con-
sistent with what psychological research has shown about the acquisition of expertise.
COMPETENCY IS POSSIBLY the most prevalent buzzword in medical education
today.To read a journal article or an official document in medical educa-
tion is to be washed over by waves of general competencies, core competencies,
cultural competency,communication-skills competency,competency assessment,
and competency-based you-name-it.
Competency sounds good, of course, as all buzzwords do.Who could possi-
bly be opposed to the idea that physicians should be competent? But is compe-
tency the right tool for the job? Does this concept do what we demand of it?
What if it is like a child's security blanket--it doesn't do anything, but it feels