Last year we published a post entitled A Glossary Of Selected Terms Used In Medical Education: Part 1, in which we defined and provided examples for some of the more vexing terms used in medical education.
This first list included Constructivism, Critical Theory, Epistemology, Ontology, Positivism, Post-positivism, and Reflexivity.
If you haven’t seen this previous post, check it out.
If you know these concepts well, let’s dive into a few more! Let us know in the comments section if I get any of these wrong, or if there are other words you’d like me to cover in future posts. Happy reading!
Academic Freedom – Academic freedom refers to the liberty of teachers, students, and academic institutions to pursue knowledge, conduct research, and disseminate findings without undue interference, censorship, or restriction. It encompasses the freedom to express opinions about academic institutions or systems and participate in professional or academic bodies without fear of retaliation or reprisal. Four primary tenants of academic freedom have been identified, including “freedom to research, freedom to publish, freedom to teach, and freedom to speak.”1 Some have argued that academic freedom and free speech are related, but find that “freedom of expression to be an individual freedom, and academic freedom to be a group-differentiated freedom with a social purpose.”2 Academic freedom underpins the mission of educational institutions to generate, preserve, and disseminate knowledge. This form of freedom is not just about protecting the rights of individual academics or students; it’s about preserving the integrity and autonomy of the academic enterprise as a whole.
Competency versus Competence – competency and competence are often used interchangeably, but they have different meanings. Competency refers to the ability to perform a specific task or activity, while competence refers to the overall ability to perform in a particular field or profession. For example, a medical student may have the competency to perform a lumbar puncture, but may not yet have the competence to diagnose a complex medical condition. While the terms are often used interchangeably, it is important to note that they are not synonymous. Competency is a narrower term that refers to the ability to perform a specific task or activity, while competence is a broader term that refers to the overall ability to perform in a particular field or profession.3 Some have even gone further to differentiate these things:
- competence – an area of work.
- competency – the behavior(s) supporting an area of work; and
- competencies – the attributes underpinning a behavior.4
Dyscompetence – Dyscompetence in a medical context refers to the failure of a healthcare professional to maintain acceptable standards in one or more areas of their professional practice. It encompasses poor performance in crucial or expected skills necessary for patient care and medical practice. Some suggest that dyscompetence can be identified and addressed through a comprehensive and nuanced approach to assessment, combining various types of information and expert judgement, much like diagnosing and treating a medical condition.5
Entrustable – The term “Entrustable” is not found in traditional dictionaries because it was specifically coined within the context of medical education by Olle ten Cate in a 2005 paper entitled Entrustability Of Professional Activities And Competency-Based Training.6 The etymology of the term combines “entrust” with the suffix “-able,” indicating the ability to be entrusted. It reflects a shift in focus from what students know to what they can do responsibly and independently.
Experienced Non-Expert – In the Dreyfus Model of Skill Acquisition, an “Experienced Non-Expert” is an individual who has progressed beyond the novice stage but has not yet achieved the level of expertise. This stage often corresponds to the “competent” or “proficient” levels in the Dreyfus Model, where individuals have gained experience and can handle complex situations through deliberate analysis and planning, yet they still rely on established rules and guidelines rather than the intuitive decision-making characteristic of true experts.7 The distinction between an expert and an experienced non-expert in the Dreyfus Model of Skill Acquisition is primarily in the level of intuition and holistic understanding they apply to their work. The line between the two is not always clear-cut and may depend on the specific context and task at hand.7
Phronesis – Phronesis, often translated as “practical wisdom” or “prudence,” is an ancient Greek concept introduced by Aristotle. It refers to the virtue of moral insight and the ability to make wise decisions in complex, variable situations. Phronesis involves not only knowing what to do but also understanding the right way to do it, balancing both moral and practical considerations.8 In medical education, phronesis is exemplified when a seasoned health care provider, through practical wisdom developed over years of practice, navigates a complex ethical dilemma where standard protocols are inadequate. For instance, a provider might have to weigh the risks and benefits of an unconventional treatment for a critically ill patient, considering not just the medical facts but also the patient’s values and quality of life. This decision-making process, blending scientific knowledge with ethical and empathetic judgment, embodies the concept of phronesis in medical practice.
References
- Keel BA. Protecting America’s secrets while maintaining academic freedom. Acad Med.2004;79(4):333-342.
- Dea S. The Evolving Social Purpose of Academic Freedom. Kennedy Inst Ethics J.2021;31(2):199-222.
- Teodorescu T. Competence versus competency: What is the difference? Performance improvement.2006;45(10):27-30.
- Moore DR, Cheng MI, Dainty ARJ. Competence, competency and competencies: performance assessment in organizations. Work study.2002;51(6):314-319.
- Schuwirth L, van der Vleuten C, Durning SJ. What programmatic assessment in medical education can learn from healthcare. Perspect Med Educ.2017;6(4):211-215.
- ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. Vol 39. England2005.
- Peña A. The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective. Med Educ Online.2010;15.
- Malik A, Conroy M, Turner C. Phronesis in Medical Ethics: Courage and Motivation to Keep on the Track of Rightness in Decision-Making. Health Care Anal.2020;28(2):158-175.
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