M.D. Program

Message From Medical Education Leadership

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Message From Associate Dean for Student Affairs

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Clinical Skills Center

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Office of Medical Education

Teaching Facilities

Graduation competencies

Overview

I. Patient Care

Use core clinical skills to deliver effective, evidence-based, and patient-centered care

History taking
Physical exam
Diagnosis & management
Procedures
Documentation & presentation

II. Knowledge

Acquire critically appraise, integrate, and apply knowledge of biomedical and clinical sciences

Principles of scientific discovery
Fundamental knowledge and clinical reasoning

III. Interpersonal and Communication Skills

Employ skills that promote both effective information exchange and collaborative relationships with patients, families, colleagues, and communities

Collaborative relationships
Information sharing

filler

IV. Professionalism

Demonstrate a commitment to
professionalism through altruism, humanism, cultural competence, accountability, and ethical-legal understanding

Altruism and humanism
Cultural competence
Accountability
Ethical-legal understanding

V. System-Based Practice

Understand the health care system to deliver
better care for individuals, better health for
populations, and more affordable care for
everyone

Health care delivery system
Health care quality improvement
Optimization of resources

VI. Life-Long Learning

Continuously improve professional
competencies through the process of life-long
learning

Critical reflection and self-improvement
Evidence-based medicine

Patient Care

What We Do....

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Competency	Patient Care
Subdomain	History Taking
Learning Objective	Performs complete or focused histories tailored to individual patient presentations and clinical settings, including patient’s cultural background and communication skills
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes the role of history taking in the Doctor-Patient encounter -Describes the influence of culture on the patient illness experience	-Obtains a comprehensive history from a standardized patient with minimal complexity, or in supervised encounter with a real patient, while developing appropriate patient rapport -Explains basic vocabulary related to history taking*	-Explains how pathophysiology and patient factors are used in history taking -Gives examples of how culture shapes communication style	-Utilizes a differential diagnosis and understanding of patho-physiology in taking a patient history. -Obtains a thorough history while developing appropriate patient rapport which is tailored to the presenting problems, including at least one complicating factor**	-Explains system factors that can constrain or facilitate history taking^† -Conducts a time-limited history based on the differential diagnosis while maintaining patient rapport and without premature closure	-Obtains a problem focused, organized history that is appropriate to the practice setting -Utilizes varying interview techniques to improve rapport and establish therapeutic relationships with patient^††	-Uses techniques to obtain a history under more challenging circumstances **^,†	-Obtains a patient-centered, problem focused, organized, and culturally sensitive history that is appropriate to the practice setting

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Competency	Patient Care
Subdomain	Physical Exam
Learning Objective	Performs comprehensive or focused physical examination using correct techniques to accurately identify common abnormalities with attention to patient comfort and modesty during exam.
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Identifies and defines the major anatomical landmarks -Demonstrates basic technique in performing the comprehensive “head-to-toe” examination -Documents basic physical exam findings	-Demonstrates ability to perform a comprehensive exam in an uncomplicated and healthy patient with attention to patient comfort and modesty -Demonstrates understanding of normal exam findings and integrates the normal exam with relevant features of the history	-Demonstrates ability to perform a problem-based physical exam with a focus on one organ system -Identifies and defines physical exam findings and integrates findings to pathophysiology of disease for each organ system	-Performs a problem-focused physical exam on a standardized patient with a complex clinical presentation involving two or more organ systems -Explains the importance of physical exam findings to clinical diagnostic reasoning in patients with actual disease processes		-Performs a comprehensive or problem-focused physical examination on patients with complex medical problems -Selects appropriate components of the physical exam based on history or presentation in different clinical settings	-Synthesizes the physical examination findings and history of patients with complex medical presentations	-Demonstrates proficiency with physical diagnosis sufficient to start an internship in any specialty*

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Competency	Patient Care
Subdomain	Diagnosis and Management
Learning Objective	Organizes, synthesizes, and interprets information from patient records, history, and physical examination to construct a differential diagnosis and treatment plan
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
	-Explains the importance of effective professional communication in developing a patient-centered management plan -Defines abnormal symptoms and signs to identify presence of disease -Constructs a problem list* for a patient -Describes stages of health behavior change	-Associates common symptoms and signs with common diseases -Composes a limited differential diagnosis for a singular medical problem based on understanding of pathophysiology	-Composes a limited differential diagnosis for each medical problem in a patient who has multiple medical problems -Constructs plan for diagnostic evaluation and initial management -Uses pathophysiology to organize problem list based on disease mechanisms -Describes the types of clinical reasoning processes, including benefits and drawbacks, that can be used in different clinical situations**	-Constructs a comprehensive and prioritized differential diagnosis for each medical problem and generates an initial evaluation and treatment plan -Assesses and prioritizes a patient’s problem list*	-Independently documents a comprehensive evaluation and treatment plan considering the risks and benefits to the patient -Utilizes evidence-based medicine to refine the differential diagnosis and management plan -Incorporates health behavior change into the management plan	-Incorporates elements of system-based practice into the management plan	-Functions as the primary coordinator of patients’ care under appropriate supervision -Demon-strates flexibility in use of analytic vs. non-analytic reasoning skills in different types of clinical scenarios** -Discusses need for consultation and supervision in diagnosis and management when appropriate

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Competency	Patient Care
Subdomain	Procedures
Learning Objective	Understands informed consent and performs uncomplicated procedures on patients or in simulation
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
	-Defines elements of informed consent for procedures		-Explains ethical and legal issues of informed consent in various patient populations and clinical scenarios* -Explains indications, contra-indications, complications, and technique for Category 1 ** procedures		-Explains indications, contra-indications, complications, and technique for common procedures (Category 1-3) -Demonstrates technical skill and ability to perform Category 2 procedures with step-by-step assistance and supervision		-Demon-strates technical skill and ability to perform Category 3 procedures ** with minimal assistance and with supervision

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Competency	Patient Care
Subdomain	Documentation and Presentation
Learning Objective	Accurately documents subjective and objective findings, assessments, plans, and treatments in paper-based and electronic health records in accordance with established guidelines. Clearly and efficiently presents patients to attending and resident physicians, consultants, peers, and allied health professionals.
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Explains the professional obligations of health care providers for patient health information (1,2)* -Lists the elements and sequence of the history, physical exam, other clinical data, assessment, and plan (1,2) -Classifies the types of medical documentation (1) **	-Retrieves clinical information from paper and electronic health records in assigned clinical settings (1,2) -Documents patient data into a SOAP note format (1) -Presents patient data organized into a SOAP note format with focus on accuracy of subjective, objective data gathering and with simple assessment and basic plan (2)	-Documents a comprehensive history and physical in a clinical setting with guidance (1)	-Documents a history and physical without guidance, addressing the complexities present in the patient’s care(1) -Explains basic documentation re-quirements for billing (1) -Presents a comprehensive history focused on clinical problems with minimal reliance on notes (2) -Demonstrates understanding that documen-tation and oral presentations vary based on clinical setting and situation (1,2)	-Presents relevant patient-centered clinical information appropriate to the clinical setting and situation to the clinical care team and allied health professionals (2) -Incorporates relevant literature into documentation and presen-tation (1,2) -Demonstrates compliance with billing and documentation requirements (1)	-Documents using a patient-centered, problem-focused approach addressing complex issues†and incorpo-rating evidence-based medicine (1) -Incorporates history, physical, assessment, and treatment plan into presen-tation appropriate to practice setting (2) -Presents the patient history at bedside and modifies the language, style, and tone as appropriate (2)	-Demonstrates understanding of effective hand-off when transferring care (1,2) -Performs appropriate documentation and presentation around transitions of care including discharge plans and needs (1,2)	-Demostrates effective and efficient communication of information needed for hand-offs (1,2) -Demonstrates succinctness and selection of key elements in documentation and presentation (1,2)

Knowledge

Welcome
Principles of Scientific Discovery
Fundamental Knowledge

Knowledge

What We Know, How We Know It, How We Use It

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Competency	Knowledge
Subdomain	Principles of Scientific Discovery
Learning Objective	Recognizes the central importance of discovery and understands how current medical knowledge is scientifically justified and evolves Critically appraises and incorporates new information in the practice of evidence-based medicine
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes scientific reasoning and its application to medicine and basic biological principles (1) -Describes hypothesis development (1) -Identifies examples of on or off campus expertise in leading edge research ) *(1,2) -Explains the value of scholarship as a critical professional responsibility (1)	-Describes the basic components of medical manuscripts in a peer reviewed journal (1,2) -Identifies resources to find critically accepted medical information (2) -Explains how current medical knowledge is scientifically justified and how that knowledge evolves (1)	-Compiles the appropriate primary literature to address a scientific question (1,2) -Describes hypothesis testing (1)	-Describes skills required for communication in the fields of medicine and scientific inquiry)** (1,2)	-Applies scientific reasoning skills and technology to promote evidence based medical practice (1,2) -Describes the ethical principles of clinical and translational research in patient care (2)	-Discusses strategies and limitations of applying new scientific information into clinical practice (1,2) -Critically appraises a peer reviewed article and adequately presents it in a journal club setting (1,2)	-Explains how to engage in medical research at this medical school and beyond (1) -Develops a testable hypothesis and/or clinical question for research (1,2) -Demonstrates skills required for communication in the fields of medicine and scientific inquiry)**(1,2)	-Critically appraises and presents a peer reviewed article and applies findings to patient care in a journal club setting (1,2) -Writes and presents a scholarly (research or clinically based) abstract (1,2)

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Competency	Knowledge
Subdomain	Fundamental Knowledge and Clinical Reasoning
Learning Objective	Applies core scientific knowledge *acquired and integrated at the molecular, cellular, organ-system, individual, and population levels to diagnose and treat disease Engages in clinical reasoning based on an understanding of the patient, pathophysiology, application of sound scientific principles, and fundamental knowledge to solve problems
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Explains normal biology from the molecular to the individual(1) -Understands the approach to solving simple clinical cases, integrating core scientific knowledge*(1,2)	-Uses understanding of disease mechanisms and patient specific data*to address simple clinical cases (1,2) -Explains how the principles of scientific discovery can be applied to basic clinical problems (2)	-Lists types of common cognitive errors in medical decision-making^†(2) -Applies core scientific knowledge * to interpretation of core clinical problems) ^††, addressing the pathophysiology and etiology (1,2)	-Applies knowledge of the principles of scientific discovery to interpretation of basic clinical problems (2) -Integrates understanding of core scientific knowledge, patient specific data *, and population-based factors to solve simple clinical cases and make decisions for patient care (1,2)	-Integrates core scientific knowledge*to gather and accurately interpret patient data and manage clinical problems (1,2) -Recognizes common cognitive errors in patient care^† (2)	-Applies core scientific knowledge* to problem solving in a dynamic clinical environment^† and addressing core clinical problems for each major specialty)^†† (1,2) -Monitors and avoids common cognitive errors)^† (2)	-Utilizes principles of scientific discovery to analyze and solve complex clinical problems (2)	-Integrates understanding of core scientific knowledge, patient specific data*, and population-based factors to solve complex clinical problems (1,2)

Interpersonal and Communication Skills

Welcome
Collaborative Relationships
Information Sharing

INTERPERSONAL AND COMMUNICATION SKILLS

HOW WE CONNECT

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Competency	Interpersonal and Communication Skills
Subdomain	Collaborative Relationships
Learning Objective	Establishes and maintains effective, collaborative, empathic, and therapeutic relationships with patients and families Establishes and maintains effective, collaborative relationships with all members of the interprofessional team
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Defines the elements of a therapeutic relationship* and factors that create and maintain it (1) -Identifies elements of communication and constructive professional relationships(2) -Describes importance of team-based care and appreciates the role of each team member (2) -Defines elements of formative feedback*(2)	-Describes how the therapeutic relationship affects the healing process and the clinician (1) -Develops a therapeutic relationship while obtaining a history (1) -Practices providing feedback to peers (2)	-Develops a therapeutic relationship while obtaining comprehensive history focused on a clinical problem (1) -Develops professional relationships with faculty, peers, and staff ^† (2)	-Practices giving feedback incorporating all key elements of effective feedback exchange (2)	-Describes strategies for dealing with the influence of non-patient related factors^†† on the therapeutic relationship (1) -Explains how to work effectively in a multidisciplinary team ^††† (2)	-Develops a therapeutic relationship that is interpersonally challenging while developing a history, assessment and treatment plan^#(1) -Uses strategies for dealing with the influence of non-patient related factors on the therapeutic relationship)^†† (1) -Uses strategies in managing conflicts within the team (2) -Demonstrates role of feedback provider for colleagues (2)	-Demonstrates how to work effectively in a multidisciplinary team^††† (2)	-Develops a therapeutic relationship with patient and family while managing multiple patients and developing practical assessments and treatment plans (1) -Describes and demonstrates key elements of leadership in team-based care (2) -Models, supports, and teaches clerkship students to develop year 3 communication competencies (1,2)

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Competency	Interpersonal and Communication Skills
Subdomain	Information Sharing
Learning Objective	Communicates clearly on scientific and medical matters with patients, family, colleagues, and community Demonstrates effective communication in shared decision-making
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Defines shared decision-making*(2)	-Organizes oral and written information to be shared with patients, family, colleagues, and community (1) -Describes the ethical principles relevant to shared decision-making (2)	-Describes the process for shared decision-making with patient and family** (2)	-Demonstrates communication and assessment strategies to ensure patient understanding of medical information (1) -Demonstrates the steps of and recognizes the threats to shared decision-making in an uncomplicated patient (2)	-Critically analyzes the effectiveness of shared decision-making in clinical cases (2)	-Communicates clearly and uses appropriate language with patients, family, colleagues, and community on scientific and medical matters***(1) -Recognizes circumstances when shared decision-making is medically-legally inapplicable (2) -Identifies strategies to manage the challenges to effective shared decision-making (2)	-Demonstrates effective skills in communication of critical information when requesting consultations or handing off care to incoming team (1,2)	-Commun-icates complex information clearly and effectively using oral, written, and electronic media (1) -Demon-strates effective and seamless shared decision-making (2)

Professionalism

Welcome
Altruism and Humanism
Cultural Competence
Accountability
Ethical Legal Understanding

PROFESSIONALISM

HOW WE ACT

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Competency	Professionalism
Subdomain	Altruism and Humanism
Learning Objective	Advocates for the interest of patients over one’s own interests, demonstrates commitment to helping those in need, and practices respect, humility, compassion, empathy, honor, and integrity
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Defines altruism and humanism -Demonstrates awareness of altruism and humanism as key principles that drive medical professionals	-Demonstrates altruistic and humanistic behavior when risk to self is minimal	-Explains the important roles of altruism and humanism in guiding a professional’s approach in patient care scenarios -Explains that maintaining altruism and humanism may come at cost of sacrificing other professionalism principles -Reflects on and appreciates one’s own strengths and weaknesses and identifies personal challenges to maintaining an altruistic/human-istic approach	-Defines and begins to anticipate the “hidden curriculum”* -Demon-strates awareness of hypothetical clinical situations that may result in challenges to altruism and humanism -Lists strategies to work through altruism and humanism challenges in hypothetical patient care scenarios**	-Exercises altruism and humanism in clinical situations*** -Identifies situations that pose challenges to altruism and humanism -Observes, processes, and discusses breaches by self and others in altruism and humanism -Acknow-ledges and expresses appreciation when altruistic and humanistic care is observed despite challenges	-Applies strategies to work through altruism and humanism challenges, altering professional priorities with appropriate justification		-Serves as a professional role model and resource for junior colleagues -Helps and teaches colleagues to develop skills necessary to deal with challenges to altruism and humanism -Applies principles of altruism and humanism to other health professionals and the community

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Competency	Professionalism
Subdomain	Cultural Competence
Learning Objective	Demonstrates the physician’s responsibility to consider the sociocultural, genetic, and epidemiologic dimensions of health and illness Recognizes and appropriately addresses gender and cultural biases in oneself, in others, and in the health delivery process
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes culture and its components in broad and inclusive terms (1) Describes one’s own cultural background and belief systems (1,2) Appreciates the meaning of health and illness from different perspectives (1)	-Describes health disparities and sociocultural, genetic, and epidemiologic factors that may contribute to these disparities (1) -Describes the impact of language on health status and health care (1,2) -Appreciates conscious and unconscious bias in oneself and its impact on health care delivery (2) -Works collaboratively with peers across cultural groups (2)	-Describes and begins to implement approaches to understanding and working effectively with patients from culturally diverse backgrounds (1,2)	-Describes the components, challenges, and benefits of the effective use of a health care interpreter (1)	-Develops rapport and effectively communicates with patients across various cultural groups (1,2)	-Demonstrates incorporation of cultural beliefs, practices, and supports into assessment and treatment planning (1)	-Demonstrates effective use of a health care interpreter in actual clinical care (1)	-Applies knowledge of health care disparities and sociocultural, genetic, and epidemiologic factors to care of patient populations across various cultural backgrounds (1)

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Competency	Professionalism
Subdomain	Accountability
Learning Objective	Demonstrates responsibility to oneself, patients, colleagues, the profession, and society*
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Defines responsibilities in team participation** -Lists student wellness resources -Demonstrates accountability in learning and accountability for achieving the UCDSOM competencies	-Demonstrates accountability to others in the learning environment **,^† -Describes components of maintaining wellness and recognizes when wellness is compromised	-Explains the intersection of personal wellness and relationships with the larger community and its impact on ability to carry out commit-ments to profession and society	-Defines professional roles and responsibilities to society, including equitable resource use and understanding of public health obligations -Develops internal resources in maintaining wellness	-Commun-icates understanding that personal wellness and commitment to patients and colleagues are sometimes in conflict -Utilizes colleagues and is available to others for consultation regarding professional commitments	-Demonstrates accountability to patient care by responsible participation in appropriate patient care activities	-Manages threats to personal wellness, recognizes threats to colleague wellness, and knows referral resources	-Manages threats to maintaining a professional relationship with patients -Explains equitable resource use, conflict of interest, and laws related to public health obligations

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Competency	Professionalism
Subdomain	Ethical and Legal Understanding
Learning Objective	Uses framework of ethical decision-making in addressing ethical issues and conflicts Demonstrates familiarity with the laws affecting medical practice and research
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes the fiduciary nature of the physician-patient relationship and the duties arising from it (1,2) -Lists the professional and legal responsibilities that are unique to physicians (1,2)	-Describes basic ethical concepts, principles, and terminology in medicine (1) -Demon-strates familiarity with the laws that affect clinical practice and research*(2) -Describes Process for Ethical Analysis Reflection and Learning (PEARL) (1) -Describes the role of ethics in ensuring quality clinical care (1)		-Demonstrates application of foundation knowledge of ethics to analysis of cases; (1,2) -Demonstrates behaviors that uphold the ethical tenets of the physician-patient relationship in an uncomplicated patient (1) -Describes the critical elements of each ethics-specific skill * (1,2) -Demonstrates awareness of threats inherent in clinical practice to ethical conduct (1)	-Describes opportunities and threats inherent in clinical practice to ethical conduct^† (1) -Discusses role of ethical principles, codes of professional conduct, legal mandates and personal morality in ethical decision-making (1,2) -Demon-strates familiarity with the resources available to address difficult ethical issues (1)	-System-atically and routinely analyzes ethical issues in clinical care (1) -Demonstrates ethics-specific clinical skills under supervision (1,2) -Describes the role of institutional ethics committees, review boards, and policies on the provision of patient care (1,2) -Discusses the implications of basic ethical and legal principles in the care of specific patient populations^†† (1,2)		-Advocates for ethical and legal responsibilities of physicians and health systems to promote quality patient care (1,2)

SBP

Welcome
Health Care Delivery System
Health Care Quality Improvement
Optimization of Resources

SYSTEM-BASED PRACTICE

HOW WE DELIVER EQUITABLE, HIGH-QUALITY CARE

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Competency	System-Based Practice
Subdomain	Health Care Delivery System
Learning Objective	Understands and applies core principles of health care delivery, organization, and finance Understands the interaction between population, community, and individual health
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes the major biological, environmental, and social determinants of health (1,2) -Identifies how health care technology may affect health, health disparities, and health care costs. (1,2) -Defines community using four perspectives* (2)	-Uses information about how communities are organized to understand clinical cases (2) -Examines clinical cases incorporating social determinants (2)	-Names and describes functions of the major players in health care delivery at a regional and national level** (1,2) -Identifies the different types of practices U.S. physicians choose in delivering care and the differences between these care models (1) -Recognizes role of emerging technologies in improving medical care (1)	-Describes how health care is delivered in other countries, in comparison with the US health care system, highlighting strengths and weaknesses (1) -Uses information about how health care is structured to understand clinical cases (1,2) -Defines community engagement and analyzes examples that have resulted in improved health and health care (2)	-Describes how the local hospital system functions and integrates with other health care service providers (1,2) -Describes the experiences of patients and their families in navigating and receiving care within the health system (1,2)	-Uses information about how systems function to advocate for patients and their families around resources, services, and access (1,2) -Plans a community engagement project (2)	-Initiates and analyzes a community engagement project (2)	-Plans an intervention to improve the health of a discrete population, from intervention development, to implementation, to measurement of outcomes (2)

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Competency	System-Based Practice
Subdomain	Health Care Quality Improvement
Learning Objective	Understands and applies principles of quality improvement in patient care Identifies and understands safety design principles in the care of patients and populations Identifies and participates in efforts to improve the health care system
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Describes the epidemiology of medical errors (2) -Explains how human factors contribute to medical errors (2)	-Explains the goals of quality improvement put forth by the Institute of Medicine (1) -Describes how provision of excellent health care involves process and systems (3)	-Describes safety design principles* (1) -Explains the value of interdisciplinary health care teams in improving patient care and outcomes (3)	-Explains how safety culture contributes to reducing medical errors (2)	-Demonstrates effective use of information technology to communicate, prevent error, and support decision-making (2, 3)	-Identifies medical errors and hazardous systems during patient care (2) -Participates as an effective member of an interdisciplinary health care team to ensure that care is continuous and reliable (3) -Describes strategies to communicate medical errors and near-errors with patients (2)		-Participates as a team member in interventions to change processes and systems of care, with the objective of improving quality or reducing harm (1)

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Competency	System-Based Practice
Subdomain	Optimization of Resources
Learning Objective	Provides cost-effective care using evidence, decision support tools, and electronic health information technology
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
	-Identifies and describes use of evidence, tools, and information technologies to support cost-effective medical decision-making		-Selects and utilizes evidence, tools, and information technologies to support cost-effective medical decision-making -Identifies and describes key drivers of the cost crisis in health care*		-Describes cost implications of common diagnostic and treatment decisions in clinical practice across major specialty domains -Explains approaches and practices that physicians can implement to address key drivers of the cost crisis in health care		-Participates in cost-effective, high-value clinical care, using tools and information technologies in real time to support decision-making

Life-Long Learning

Welcome
Critical Reflection and Self-Improvement
Evidence-Based Medicine

LIFE-LONG LEARNING

HOW WE GROW AND IMPROVE

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Competency	Life-Long Learning
Subdomain	Critical Reflection and Self-Improvement
Learning Objective	Uses critical reflection and feedback from multiple sources and engages in appropriate learning activity to improve knowledge, professional skills, and attitude*
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
-Understands principles of active learning -Describes how feedback* is part of the learning process for individuals, groups, and the overall learning community -Describes individual strengths and weaknesses and sets learning goals for personal development -Establishes a portfolio to document professional and personal development in the UCDSOM competencies	-Applies principles of active learning** -Identifies multiple strategies for feedback and helping incorporate that feedback -Identifies areas of deficiency and constructs an individualized plan for developing those competencies	-Describes reaction patterns in feedback exchange as recipient -Demonstrates strategies for seeking and incorporating feedback	-Critically reflects on one’s performance in identifying strengths and challenges, setting individual learning goals, and engaging in appropriate activity to meet those goals -Uses feedback to make improvements towards learning goals -Uses portfolio documentation of professional and personal development in the UC Davis School of Medicine competencies	-Recognizes the barriers to effective feedback exchange inherent in the clinical setting^† -Uses strategies to solicit and incorporate feedback in clinical settings	-Appraises UC Davis School of Medicine portfolio documentation of professional and personal development in the competencies		-Documents evidence of critical reflection from clinical settings including incorporating feedback and consideration of past experiences to inform development of a plan for the future -Explains portfolio documentation of professional and personal development in the UCDSOM competencies

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Competency	Life-Long Learning
Subdomain	Evidence-Based Medicine
Learning Objective	Identifies clinical questions in patient care and identifies, appraises, assimilates, and applies scientific evidence from the literature to the care of individual patients Applies clinical evidence and epidemiology appropriately in patient care
Milestones
Year I		Year II		Year III		Year IV
Mid	End	Mid	End	Mid	End	Mid	End
	-Defines a clinical question in the context of core scientific knowledge* and patient care and begins to access appropriate resources for answering this question (1) -Identifies basic methodological terms and principles used to study biomedical research and population health (2)		-Appraises, assimilates, and applies scientific evidence in discussion of cases (1) -Uses basic epidemiologic terms to describe disease patterns** (2)		-Defines clinical questions, accesses appropriate resources for answering these questions, and applies findings to patient care (1) -Applies knowledge of study design and statistical methods to the appraisal of clinical studies (2) -Applies epidemiologic terms to benefits and harms as related to the care of individual patients and populations **(2)	-Identifies clinical questions as they emerge in clinical care activities and routinely identifies, appraises, and applies relevant, high quality evidence in clinical decision-making (1) -Describes benefits and harms of an intervention using appropriate epidemiologic terms (2)	-Determines whether clinical evidence can be applied to an individual patient (2) -Accesses and appropriately applies information from practice guidelines in patient care(2) -Applies knowledge of disease patterns to assess the value of diagnostic tests based on patient's risk of disease (2)