Drexel University College of Medicine
Graduation Competencies

Statement of Purpose
Our goal is to prepare our medical graduates to be competent, caring physicians who strive to keep up with the explosion of medical knowledge and master a body of knowledge through lifelong learning and continuous professional development. Our graduates will become change agents within their spheres of influence and manage patients, populations, and systems with an approach that embraces continuous quality improvement, reflective practice, interdisciplinary effectiveness, and cultural competence. They will practice medicine within a bio-psychosocial model of care, and be as adept in maintaining health and healing patients as they are at managing diseases. Our physicians of the future will possess leadership skills to manage teams and advocate for patients and changes in the health care system to establish a health care system that is high in quality and appropriate in cost.

Toward these ends, our students should demonstrate: 1) the ability to obtain, assess and apply knowledge of the medical sciences, the social sciences and the humanities; 2) skills in the collection of clinical information, in communication and in the building of rapport with patients in order to facilitate diagnosis and therapy; and 3) the values, attitudes and professional behavior that promote caring and concern for the individual and society.

College of Medicine Exit Objectives
In recognition of the continuum of undergraduate medical education to graduate medical education (GME) to continuous professional development of the physician in practice, these updated and refined Exit Objectives have been developed to integrate specifically with the ACGME general competencies that now exist in GME and soon will be incorporated into maintenance of certification and licensure.  The 6 ACGME competencies are interdependent and often overlapping.

The following Exit Objectives embrace the Accreditation Council for Graduate Medical Education general competencies: Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice, and the Institute of Medicine’s List of 6 health areas that need immediate attention by all practitioners and participants in the health care system. The IOM report, Crossing the Quality Chasm, mandated that all health care should be:

• Safe—avoiding injuries to patients from the care that is intended to help them.
• Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).
• Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
• Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient—avoiding waste, including waste of equipment, supplies, ideas, and energy.
• Equitable—providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

The Exit Objectives reflect that the diversity of the patient population and the diversity of the student body and faculty have relevance for both the educational experience and outcomes.  In addition, it is important to recognize that the terms, family and community, are broader in context than traditional definitions.

The following is a list of objectives under each ACGME competency that the College of Medicine expects all medical students to have upon graduating from the four-year medical school curriculum.

Patient Care
Trainees must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health in all patients across the continuum of age.

By the time of graduation, students are expected to:

1. Use appropriate interviewing skills to elicit an accurate and thorough history addressing the onset and persistence of illness in the context of the patient’s life.
2. Perform a detailed and accurate physical examination.
3. Choose diagnostic, management and therapeutic interventions based on sound reasoning using all the tools of evidence-based medicine.
4. Involve patients as active participants in the decision-making and the care plan.
5. Recognize the importance of the patient’s family (traditional or self-defined) and community; and utilize appropriate community resources in caring for patients.
6. Demonstrate sensitivity in the care of all patients by recognizing each of them as an individual, with the appropriate consideration of diversity in age, culture, disability, educational background, ethnicity, gender, gender identity, race, religion, sexual orientation, and socioeconomic background.
7. Work collaboratively with all members of the healthcare team.
8. Recognize the limitations of level of training and seek help appropriately.
9. Protect patients from harm.
10. Advocate for patient interests.

Medical Knowledge
Trainees must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.

By the time of graduation, students are expected to:

1. Demonstrate basic knowledge of normal structure, development, and function of major organ systems and the body as a whole in the context of health and disease.
2. Identify the molecular, biochemical, and cellular mechanisms that are important in maintaining health and contribute to pathophysiology of disease.
3. Describe common disease entities, including their characteristic signs and symptoms, etiology, epidemiology, and pathophysiology.
4. Delineate the mind-body interactions in health and disease.
5. Identify the determinants of poor health, including the economic, psychological, social, and cultural factors that contribute to its development and/or continuation.
6. Delineate interventions available for relieving pain and suffering.
7. Select, justify, and interpret appropriate clinical tests and diagnostic procedures with attention to benefits, harms and cost.
8. Use clinical reasoning processes to interpret data to derive a differential diagnosis and develop a clinical management plan.
9. Utilize the basic concepts of evidence-based medicine to analyze the literature.
10. Describe basic elements of the scientific method and demonstrate critical appraisal skills necessary to evaluate the medical literature as it applies to clinical management.
11. Recognize and initiate management of life-threatening conditions.
12. Perform common technical procedures accurately and safely.
13. Identify social and environmental factors that contribute to violence and trauma.
14. Describe how team dynamics impact patient care and patient safety.
15. Delineate elements of safety and quality improvement patient care programs.
16. Demonstrate knowledge of the ethical, moral and legal foundations of medical care.

Practice-based Learning and Improvement
Trainees must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.

By the time of graduation, students are expected to:

1. Demonstrate the ability to identify strengths and weaknesses in their knowledge and skills.
2. Seek opportunities to strengthen deficits in knowledge and skills.
3. Utilize established quality recommendations to provide care to patients and to help develop interventions to improve safe, quality patient care.
4. Demonstrate the ability to give and receive constructive feedback that is improvement-focused to enhance the functioning of the medical team and patient care.
5. Evaluate study design, methods and results as they apply to current best practice.
6. Incorporate evidence-based medicine principles into day-to-day practice.
7. Utilize information technology in the practice of life-long learning and to support patient care decisions and promote patient education decisions.
8. Contribute to the education of patients, families, students, other health professionals, and the community.

Interpersonal and Communication Skills
Trainees must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

By the time of graduation, students are expected to:

1. Demonstrate effective and appropriate verbal and nonverbal techniques to elicit a patient history.
2. Use effective communication skills to educate patients and to counsel them to modify health risk behaviors.
3. Involve patients and their families in the patient care plan.
4. Communicate with patients and families regarding advanced care directives and end of life care.
5. Communicate effectively with patients, families, and the public across a broad range of socioeconomic and cultural backgrounds.
6. Communicate effectively with physicians, other health professionals, and health related agencies.
7. Communicate effectively in difficult situations including:  giving bad news, disclosing medical errors and working with distressed patients and their family members.
8. Articulate an accurate clinical question when requesting consultation.
9. Document medical information accurately and timely. 

Professionalism
Trainees must demonstrate adherence to ethical principles, development of physician attributes, and commitment to carrying out professional responsibilities.

By the time of graduation, students are expected to:

1. Uphold the primacy of patient welfare with particular attention to patients who are medically, psychologically or socially vulnerable.
2. Apply principles of autonomy, beneficence and justice, and work to resolve ethical dilemmas as they arise in clinical practice.
3. Show commitment to lifelong cultivation of empathy, compassion, self-compassion, and self-care.
4. Self-regulate personal feelings toward patients and families that impede effective communication.
5. Show commitment to professional excellence and lifelong learning to provide patients with medical care informed by the most recent medical advances.
6. Demonstrate honesty, integrity, reliability and responsibility in all interactions with patients, families, colleagues and other professional contacts.
7. Maintain appropriate patient relations and interpersonal boundaries.
8. Respond appropriately to observed breaches of medical professionalism or unsafe medical practices.
9. Identify and manage personal and professional conflicts of interest.
10. Maintain patient confidentiality.
11. Demonstrate a professional image in behavior and dress.

Systems-based Practice

Trainees must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

By the time of graduation, students are expected to:

1. Describe the major organizational models of health care delivery.
2. Compare and contrast employer-based health insurance with government-subsidized plans.
3. Demonstrate the effective use of health information resources and technology in medical decision-making.
4. Describe the costs, benefits and potential harms of tests and procedures.
5. List available community resources beneficial in caring for patients.
6. Describe how to coordinate patient care within a health system.
7. Identify health disparities brought about by age, culture, disability, educational background, ethnicity, gender, gender identity, race, religion, sexual orientation, and socioeconomic background.
8. Advocate for quality patient care and optimal patient care systems.
9. Describe how identifying systems errors and implementing potential systems solutions may improve care.
10. Describe the complexities of medical practice with regard to moral, ethical and legal issues.
11. Work collaboratively in inter-professional teams to enhance patient safety and improve quality of care.

Drexel University College of Medicine Graduation Competencies               July 1, 2010