Michael Eraut, Benedict du Boulay
The increasing codification and regulation of medical competence highlights the multi-faceted and complex nature of being a doctor. Not only are extensive skills and knowledge expected within the doctor's area of specialism, but also high levels of communicative ability, ethical understanding and responsibility, teamworking capability and organizational ability. Although much is learned pre-registration, the greater part of a doctor's overall and effective competence and judgement is developed post-registration: through active involvement in a large number of cases; through teaching and supervision; through discussion and teamwork; through reflection on practice; and through formal study. Two questions underpin this review. First, what is the nature of medical competence and judgement? Second, how can post-registration medical education be organized so as to develop it in an effective and efficient manner? However the first question is answered, it is clear that the pivotal learning experience is, and will remain, the doctor's exposure to, and involvement in, a wide range of real cases; cases where difficult judgements have to be made, often with uncertain and insufficient data and sometimes against severe time pressures.
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