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From Competencies to Human Interests: Ways of Knowing and Understanding in Medical Education

Kumagai, Arno K. MD

doi: 10.1097/ACM.0000000000000234

When considering the teaching and learning of topics of social relevance in medicine, such as professionalism, medical ethics, the doctor–patient relationship, and issues of diversity and social justice, one is tempted to ask, are the ways of knowing in these fields different from that in the biomedical and clinical sciences? Furthermore, given that the competency approach is dominant in medical education, one might also ask, is the competency model truly appropriate for all of the types of knowledge necessary to become a good physician? These questions are not merely academic, for they are at the core of how these subjects are taught, learned, and assessed.

The goal of this article is threefold: first, to explore the nature of knowing and the educational goals in different areas of medicine and, in particular, those areas that have social relevance; second, to critically review the concept of competencies when applied to education in these areas; and third, to explore alternative strategies for teaching, learning, and assessment. This discussion reflects a view that the goal of education in areas of social relevance in medicine should be the enhancement of an understanding of—a deep and abiding connection with—the social responsibilities of the physician. Moving beyond competencies, this approach aspires toward the development of practical wisdom (phronesis) which, when embodied in the physician, links the knowledge and skills of the biomedical and clinical sciences with a moral orientation and call to action that addresses human interests in the practice of medicine.

Dr. Kumagai is professor of internal medicine and medical education and director, Family Centered Experience and Longitudinal Case Studies Programs, University of Michigan Medical School, Ann Arbor, Michigan.

Funding/Support: Career Development Grant from University of Michigan Center for Research in Learning and Teaching.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Kumagai, 3908D Learning Resource Center #5726, University of Michigan Medical School, Ann Arbor, MI 48109-0726; telephone: (734) 615-4886; fax: (734) 936-2236; e-mail:

© 2014 by the Association of American Medical Colleges