An ArtWalk and Reflections on the Trainee Portrait of Competency

By: Mary Ellen J. Goldhamer, MD MPH (@megoldhamer)

While on a trip to the Windy City for a meeting, I spent a few hours in the Art Institute of Chicago, which was featuring the exhibit, “Salvador Dalí: The Image Disappears.”¹

The artwork was complex, intense, and vivid, and it was difficult to fully absorb each piece while keeping pace with the moving crowd. The group next to me was actively engaged in discussion, sharing perspectives that collectively led to a deeper understanding of each piece. To gain further insight, I quietly joined the outskirts of this group and through active listening, I came to appreciate more nuance in the portraits before me.

How does this ArtWalk relate to competency based medical education?

First, let’s look at a Dalí portrait together.²

While touring the exhibit alone, I saw: A bowl of fruit. A scarf. A dog. A child.

What do you see?

Quietly listening to those around me, I saw not only one but two dogs, a possible mountain lion, a face, and more.

Drawing on these collective insights, can you now see more than when you first viewed the portrait alone?

And so, I continued for the better part of an hour — actively listening and gaining deeper insights into each portrait, seeing more on this ArtWalk through the collective perspectives of others. Later, while walking along the streets of Chicago (and looking for Magnolia Bakery and their famous banana pudding), I started to draw similarities between this ArtWalk experience, competency-based medical education, and the assessment of residents and fellows.

I realized that in many ways, this ArtWalk modeled the assessment practices on clinical competency committees (CCCs).³ These committees take work-placed based assessments representing “snapshots” of trainee skills and competencies from each rotation or major assignment,⁴ and together synthesize these individual assessments to create a unique “competency portrait” of each resident or fellow as they progress through training.

I’d like to share key takeaways from my ArtWalk and analogies to competency-based medical education, assessment, and the creation of the trainee “competency portrait.”

First, the structure, process, and composition of the CCC are key to creating an accurate trainee “competency portrait.”^3,5–7 CCC members should be representative of the program, have a shared mental model,⁸ and understand the competency framework and roadmap for graduation and readiness for independence. As all perspectives were shared and valued by the group on the ArtWalk, all members of the CCC should be encouraged to share insights and perspectives, especially those that may counter others’ perspectives.⁵ These discussions will serve to inform a deeper understanding of each trainee’s unique strengths and areas for improvement.

Second, the trainee “competency portrait” ideally will be shaped through multi-source (360-degree) assessment contributed by faculty, peers, patients, other healthcare professionals/nurses, and trainee self-assessment.⁴  

Sufficient numbers of high-quality competency-based assessment “snapshots” over the course of training will contribute multiple perspectives to shape and inform the “competency portrait” over time. This point is underscored by a study led by the Partners (now Mass General Brigham) Office of Graduate Medical Education (MGB GME) a few years ago.  We conducted a communication-focused objective structured clinical exam (OSCE) during GME orientation that included 97 incoming interns to eight residency programs in six specialties at four hospitals.⁹ We then followed communication ratings on multi-source evaluations across the intern year. We found that lower OSCE performance scores were associated with communication concerns on assessments and that peers, nurses, and patients were 3-5 times more likely than faculty to report concerns in the area of communication on end-of-rotation evaluations. While this study only included interns from one large academic medical center, it underscores that competency-based evaluation “snapshots” from all members of the healthcare team contribute importantly to the trainee portrait of competency.

Third, the “competency portrait” will ideally be guided by a shared mental model⁸ of the Accreditation Council for Graduate Medical Education (ACGME) core competencies and Milestones,⁴ specialty- specific entrustable professional activities (EPAs),¹⁰ or their equivalent.

While frameworks of competency determination may vary by program, specialty, or each country’s accreditation guidelines, it is the iterative assessment on the framework that ensures trainees are on track to achieve competency. Just as those on the ArtWalk had a structured approach to observing and interpreting each piece of art, trainees should familiarize themselves with the guiding frameworks that serve as roadmaps to ensure readiness for graduation and independent practice.   

Lastly, trainees share responsibility to co-produce their “competency portrait.”

As I benefited from the insights and guidance of the group to better understand Salvador Dalí s work, residents and fellows will benefit from periodic self-assessment, active contributions to individual learning plans,⁷ and both seeking and responding to CCC feedback. Self-reflection coupled with feedback from trusted mentors, program directors, core faculty, and coaches can play a critical role in trainee professional development.

Let’s close with one more Dalí portrait.¹¹

What do you see? A woman’s face. A living room? Anything else? Now consult a colleague and share insights and perspectives. Can you help each other see aspects of the portrait you may not have seen alone?

Thank you for taking the time to read this blog. I hope you enjoyed the portraits, and I welcome your comments, thoughts, and reflections on the link between art and medicine,¹² competency based medical education, assessment, and the trainee portrait of competency. Engaging in a collaborative exploration of art illustrates how diverse perspectives, structured frameworks, and active self-reflection are essential for creating a comprehensive and accurate “competency portrait” of trainees in medical education.

About the Author:

Mary Ellen J. Goldhamer, MD MPH is assistant professor of medicine and core faculty, Clinical Skills Assessment Program, Harvard Medical School; director of faculty continuing medical education, Division of General Internal Medicine, Massachusetts General Hospital; and co-investigator, “Promotion in Place” pilot at Mass General Brigham, funded by the American Medical Association Reimagining Residency grant program. 

References (Many references came from a fantastic CCC supplement from JGME found here: https://meridian.allenpress.com/jgme/issue/13/2s):

1. Exhibit: Salvador Dali: The Image Disappears, The Art Institute of Chicago, February 18, 2023- June 12, 2023. Accessed October 24, 2024. https://www.artic.edu/exhibitions/9713/salvador-dali-the-image-disappears
2. Apparition of Face and Fruit Dish on a Beach, 1938 Salvador Dalí. Wadsworth Atheneum Museum of Art, Hartford, Connecticut. © Salvador Dalí, Fundació Gala-Salvador Dalí / Artists Rights Society (ARS), New York, 2022. Accessed October 24, 2024. https://www.artic.edu/exhibitions/9713/salvador-dali-the-image-disappears
3. Andolsek KM, Jones MD, Ibrahim H, Edgar L. Introduction to the Milestones 2.0: Assessment, Implementation, and Clinical Competency Committees Supplement. J Grad Med Educ. 2021;13(2s):1-4. doi:10.4300/JGME-D-21-00298.1
4. Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements 2023. 2023. Accessed October 24, 2024. https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf
5. Hauer KE, Edgar L, Hogan SO, Kinnear B, Warm E. The Science of Effective Group Process: Lessons for Clinical Competency Committees. J Grad Med Educ. 2021;13(2s):59-64. doi:10.4300/JGME-D-20-00827.1
6. Ekpenyong A, Padmore JS, Hauer KE. The Purpose, Structure, and Process of Clinical Competency Committees: Guidance for Members and Program Directors. J Grad Med Educ. 2021;13(2s). doi:10.4300/JGME-D-20-00841.1
7. Andolsek K, Padmore J, Hauer KE, Ekpenyong A, Edgar L,, Holmboe E. Accreditation Council for Graduate Medical Education (ACGME) Clinical Competency Committees A Guidebook for Programs 3rd Edition. 2020. Accessed May 14, 2022. https://www.acgme.org/globalassets/acgmeclinicalcompetencycommitteeguidebook.pdf
8. Edgar L, Jones MD, Harsy B, Passiment M, Hauer KE. Better Decision-Making: Shared Mental Models and the Clinical Competency Committee. J Grad Med Educ. 2021;13(2s):51-58. doi:10.4300/JGME-D-20-00850.1
9. Goldhamer MEJ, Cohen A, Brooks M, Macklin EA, Co JPT, Weinstein D. Use of an objective structured clinical exam (OSCE) for early identification of communication skills deficits in interns. Med Teach. 2018;40(1):40-44. doi:10.1080/0142159X.2017.1387646
10. Cheung WJ, Bhanji F, Gofton W, et al. Design and Implementation of a National Program of Assessment Model – Integrating Entrustable Professional Activity Assessments in Canadian Specialist Postgraduate Medical Education. Perspect Med Educ. 2024;13(1):44-55. doi:10.5334/pme.956
11. Mae West’s Face Which May be Used as a Surrealist Apartment (1934–35) Art Institute of Chicago © Salvador Dalí, Fundació Gala-Salvador Dalí / Artists Rights Society (ARS), New York, 2018. . Accessed October 24, 2024. https://www.artic.edu/exhibitions/9713/salvador-dali-the-image-disappears
12. Cohen SM, Dai A, Katz JT, Ganske IM. Art in Surgery: A Review of Art-based Medical Humanities Curricula in Surgical Residency. J Surg Educ. 2023;80(3):393-406. doi:10.1016/j.jsurg.2022.10.008

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