What Is Core Medical Knowledge for the 21st Century?

• In Event: The GPS of Medical Knowledge for the 21st Century

Abstract

For more than a century, defining the core knowledge necessary for engaging in medical practice has been an important activity of state licensing bodies, accreditation agencies, certification boards, and professional organizations. Contemporaneous understandings of medical core content have been articulated across time in vehicles as distinct as the basic science boards of the early 20th century, the core competencies of undergraduate and graduate medical education, and the content outlines of medical and surgical subspecialties. (1,2,3). The term core knowledge has implied knowledge that physicians must have as immediately accessible parts of their being and that enable successful patient care. Over time, the profession’s understanding of core knowledge has become much more based on specialty, subspecialty, and work context than on a body of knowledge associated with the profession as a whole. Twenty-first century medicine, with its exponential growth in knowledge, reliance on technology and use of artificial intelligence and decision-support tools will demand new types of core knowledge. Although major components of core knowledge will remain discipline specific, an increasing proportion will be generalizable across specialties and work environments.

Some of the 21st century physician’s core knowledge will continue to play a direct and immediate role in the care of a particular patient. Examples of this type of knowledge are 1) a framework for approaching a sudden patient emergency and 2) an understanding of the relationship between infection prevention and handwashing between patient visits. Such core knowledge influences the physician’s behaviour with distinct patients.

A second set of core knowledge components will have a less direct link to a specific patient but will influence the physician’s overall approach to clinical work. Examples include 1) knowing how to work effectively with other health care professionals and 2) recognizing situations in which cognitive errors are likely to occur. This core knowledge will influence the care of patients less directly but in important ways.

The most substantial change in what constitutes core knowledge will be expectations that have nothing to do with the discipline-specific content of physicians’ work but everything to do with whether they know how to 1) access information to remain up-to-date, 2) use decision-support tools to improve decision-making and improve patient safety, and 3) use technology in care of patients. Furthermore, we will expect physicians to judge the quality of information sources and to evaluate the effectiveness of technologies for patient care.

It is very difficult to uncouple core medical knowledge from the skills and behaviors of the profession. Going forward, there will be increasing emphasis on coupling core knowledge – how to access, judge, and use the various technologies and tools – with the core behaviors of using these technologies and tools. One can imagine physicians who know about decision-support tools but do not use them or physicians with access to technology that can facilitate longitudinal learning but fail to remain current in their disciplines. The technology itself will make such issues and their consequences more obvious, and the profession should respond.

Author

• Lois Margaret Nora, Northeast Ohio Medical University