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Promoting Fundamental Clinical Skills: A Competency-Based College Approach at the University of Washington

Goldstein, Erika A. MD, MPH; MacLaren, Carol F. PhD; Smith, Sherilyn MD; Mengert, Terry J. MD; Maestas, Ramoncita R. MD; Foy, Hugh M. MD; Wenrich, Marjorie D. MPH; Ramsey, Paul G. MD


The focus on fundamental clinical skills in undergraduate medical education has declined over the last several decades. Dramatic growth in the number of faculty involved in teaching and increasing clinical and research commitments have contributed to depersonalization and declining individual attention to students. In contrast to the close teaching and mentoring relationship between faculty and students 50 years ago, today’s medical students may interact with hundreds of faculty members without the benefit of a focused program of teaching and evaluating clinical skills to form the core of their four-year curriculum. Bedside teaching has also declined, which may negatively affect clinical skills development.

In response to these and other concerns, the University of Washington School of Medicine has created an integrated developmental curriculum that emphasizes bedside teaching and role modeling, focuses on enhancing fundamental clinical skills and professionalism, and implements these goals via a new administrative structure, the College system, which consists of a core of clinical teachers who spend substantial time teaching and mentoring medical students. Each medical student is assigned a faculty mentor within a College for the duration of his or her medical school career. Mentors continuously teach and reflect with students on clinical skills development and professionalism and, during the second year, work intensively with them at the bedside. They also provide an ongoing personal faculty contact. Competency domains and benchmarks define skill areas in which deepening, progressive attention is focused throughout medical school. This educational model places primary focus on the student.

Dr. Goldstein is director, University of Washington School of Medicine (UWSOM) Colleges, UWSOM, Seattle, Washington, and associate professor, Department of Medicine, UWSOM.

Dr. MacLaren is associate dean for student affairs and chief administrative officer for academic affairs, UWSOM, Seattle, Washington, and lecturer, Department of Medical Education and Biomedical Informatics, UWSOM.

Dr. Smith is assistant professor, Department of Pediatrics, UWSOM, Seattle, Washington.

Dr. Mengert is professor, Department of Medicine, Division of Emergency Medicine, UWSOM, Seattle, Washington.

Dr. Maestas is associate professor, Department of Family Medicine, UWSOM, Seattle, Washington.

Dr. Foy is associate professor, Department of Surgery, UWSOM, Seattle, Washington.

Ms. Wenrich is director of medical affairs special research and communications projects, UWSOM, Seattle, Washington, and affiliate instructor, Department of Medical Education and Biomedical Informatics, UWSOM.

Dr. Ramsey is vice president for medical affairs and dean of the UWSOM, Seattle, Washington, and professor of medicine, UWSOM.

Correspondence should be addressed to Dr. Goldstein, Director, University of Washington School of Medicine Colleges, Box 357430, Seattle, WA 98195-7430; telephone: (206) 685-1202; fax: (206) 221-3003; e-mail: 〈〉.

© 2005 Association of American Medical Colleges