ABSTRACT
Competence and professionalism are complex, interrelated, multidimensional constructs. Competence is composed of many different measurable variables, latent variables, and factors relating behavior to environment. Medical competence is a reciprocal link and interaction of a person’s medical knowledge, skills, attitudes, and behavior. B. Hodges and L. Lingard have pointed out that in the past decade competence has grown to the status of a “god term” in medicine and other healthcare professions. The present views define medical competence and professionalism as the ability to meet the relationship-centered expectations required to practice medicine competently. A variety of professional organizations have weighed in on the constructs of competence and professionalism. G. E. Miller proposed a framework for assessing levels of clinical competence as a pyramid: the lowest two levels test cognition, followed by competence, performance, and at the pinnacle, action. The use of oral exams for assessing clinical competence continued for a long time despite its limitations of reliability and validity.
