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Giving Context to the Physician Competency Reference Set: Adapting to the Needs of Diverse Populations

Eckstrand, Kristen L. MD, PhD; Potter, Jennifer MD; Bayer, Carey Roth EdD, RN, CSE; Englander, Robert MD, MPH

doi: 10.1097/ACM.0000000000001088

Delineating the requisite competencies of a 21st-century physician is the first step in the paradigm shift to competency-based medical education. Over the past two decades, more than 150 lists of competencies have emerged. In a synthesis of these lists, the Physician Competency Reference Set (PCRS) provided a unifying framework of competencies that define the general physician. The PCRS is not context or population specific; however, competently caring for certain underrepresented populations or specific medical conditions can require more specific context. Previously developed competency lists describing care for these populations have been disconnected from an overarching competency framework, limiting their uptake. To address this gap, the Association of American Medical Colleges Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development adapted the PCRS by adding context- and content-specific qualifying statements to existing PCRS competencies to better meet the needs of diverse patient populations. This Article describes the committee’s process in developing these qualifiers of competence. To facilitate widespread adoption of the contextualized competencies in U.S. medical schools, the committee used an established competency framework to develop qualifiers of competence to improve the health of individuals who are lesbian, gay, bisexual, transgender; gender nonconforming; or born with differences in sexual development. This process can be applied to other underrepresented populations or medical conditions, ensuring that relevant topics are included in medical education and, ultimately, health care outcomes are improved for all patients inclusive of diversity, background, and ability.

K.L. Eckstrand is a psychiatry resident, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and founding chair, Association of American Medical Colleges, Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development, Washington, DC.

J. Potter is associate professor of medicine, Harvard Medical School, Cambridge, Massachusetts, and director, Women’s Health Research, Fenway Institute, Boston, Massachusetts.

C.R. Bayer is associate professor, Morehouse School of Medicine, and associate director of educational leadership, Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, Georgia.

R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, and is currently adjunct professor of pediatrics, George Washington School of Medicine, Washington, DC.

Funding/Support: This work was funded by a grant from the Josiah Macy Jr. Foundation.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Kristen L. Eckstrand, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara St., Pittsburgh, PA 15213-2593; telephone: (412) 246-5320; e-mail:

© 2016 by the Association of American Medical Colleges