MD Competency Milestones

The School of Medicine curriculum provides a set of educational experiences designed to support students’ mastery of the core knowledge, skills, and attitudes needed to achieve their goals as physicians, researchers, teachers, and public servants. Throughout the curriculum, medical students’ achievement of these competencies is assessed through a variety of methods that constitute a program of assessment. This coordinated and integrated approach provides frequent feedback and practice so that students have the information they need to advance their learning. In addition, there are periodic high-stakes assessments that ensure that students are ready to advance to the next stage in their training.

The UCSF MD Program requires students to achieve competence as defined by the program objectives in the seven competencies listed below. For each competency, a set of milestones defines the expected progress throughout medical school and upon graduation. All students achieve core competencies, with Bridges Curriculum Milestones elaborating topics such as inquiry and systems improvement.

Patient Care

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
PC1 F1. Gather basic histories from patients, families, and electronic health records relevant to clinical presentation, patient concerns, and structural factors that impact health	PC1 F2. Gather complete and focused histories from patients, families, and electronic health records in an organized manner, appropriate to the clinical situation and the individual, interpersonal, and structural factors that impact health	PC1 (graduation). Gather complete and focused histories from patients, families, and electronic health records in an organized manner, appropriate to the clinical situation and the individual, interpersonal, and structural factors that impact health
PC2 F1. Perform basic elements of a physical exam relevant to clinical presentation and patient concerns and identify common abnormalities, with attention to patient comfort	PC2 F2. Conduct a complete or focused physical exam in an organized, efficient, and fluid sequence, interpreting abnormalities and maintaining patient comfort	PC2 (graduation). Conduct complete and focused physical exams, using technology-enhanced physical diagnosis tools where appropriate, interpreting abnormalities and maintaining patient comfort
PC3 F1. Present patient information with an assessment and differential diagnosis in an organized and logical manner for common patient complaints	PC3 F2. Present patient information with an assessment, differential diagnosis, and initial plans in an organized and logical manner	PC3 (graduation). Present encounters efficiently, including relevant gathered information, assessment, and plan
PC4 F1. Document patient encounters with an organized and reasoned report of information that supports a preliminary assessment and plan	PC4 F2. Document patient encounters promptly, including independent authorship for reporting of information, assessment, and initial plan	PC4 (graduation). Document patient encounters accurately, efficiently, and promptly including independent authorship for reporting of information, assessment, and plan
PC5 F1. Practice the basic principles of universal precautions in all settings	PC5 F2. Observe, assist, or perform procedures and skills as detailed in clerkship learning objectives, following universal precautions and sterile technique	PC5 (graduation). Perform common procedures safely and correctly, including participating in obtaining informed consent, following universal precautions and sterile technique, and attending to patient comfort
PC6 F1. Contribute to a team-based approach to managing patients with acute or chronic illness or preventive health needs, and perform systems tasks for patients within a clinical microsystem	PC6 F2. With appropriate supervision, manage patients with acute and chronic illness in the inpatient and ambulatory setting, and recognize patients' need for services to address their medical and social needs	PC6 (graduation). Manage patients as part of a team, including prioritizing patient care tasks efficiently to provide high-quality care that addresses their medical and social needs

Medical Knowledge

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
MK1 F1. For the UCSF 49, establish and maintain basic knowledge necessary for patient care that addresses the maintenance of human health and the etiology, pathogenesis, and manifestations of medical problems	MK1 F2. For the UCSF 49, continue to establish and maintain knowledge necessary for patient care that addresses the maintenance of human health and the etiology, pathogenesis, manifestations, treatment, and management of medical problems	MK1 (graduation). For the UCSF 49, establish and maintain knowledge necessary for the preventive care, diagnosis, treatment, and management of medical problems
MK2 F1. Demonstrate curiosity, objectivity, and a recognition of the limits of medical science in acquisition of knowledge	MK2 F2. While recognizing the limits of medical science, apply an inquiry-oriented and analytic approach to learning and patient care	MK2 (graduation). Through an inquiry-oriented and analytic approach to learning and patient care, develop and implement approaches for generating and applying new knowledge, including an individual course of study that emphasizes inquiry, discovery, and dissemination
MK3 F1. For the UCSF 49, identify the range of diagnostic testing available and be able to articulate the factors that determine when a given diagnostic test is appropriate	MK3 F2. For the UCSF 49, select, justify, and interpret diagnostic tests and imaging	MK3 (graduation). For the UCSF 49, select, justify, and interpret diagnostic tests and imaging
MK4 F1. Reason through basic clinical problems using a systematic approach that includes problem representation, generation of problem lists and hypotheses, and construction of prioritized differential diagnoses	MK4 F2. For the UCSF 49, solve clinical problems using a systematic approach that includes problem representation, generation of problem lists and hypotheses, and construction of prioritized differential diagnoses	MK4 (graduation). For the UCSF 49, diagnose and explain clinical problems
MK5 F1. Identify the main forms of electronic decision support tools available and apply these tools to common clinical problems	MK5 F2. Select and use the appropriate electronic decision support tool in common clinical situations to inform clinical reasoning and decision making	MK5 (graduation). Use electronic decision support tools to inform clinical reasoning and decision making
MK6 F1. For the UCSF 49, identify the basic preventive, curative, and/or palliative therapeutic strategies and describe factors that impact the choice of management strategies	MK6 F2. For the UCSF 49, select basic preventive, curative, and/or palliative therapeutic strategies	MK6 (graduation). For the UCSF 49, select and apply basic preventive, curative, and/or palliative therapeutic strategies

Practice-Based Learning and Improvement

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
PBLI1 F1. Locate, appraise, and apply scientific evidence in discussion of paper, simulated, or real cases	PBLI1 F2. Locate, appraise, and apply scientific evidence from individual studies, systematic reviews, and/or evidence-based guidelines in providing appropriate patient care	PBLI1 (graduation). Locate, appraise, and apply evidence from scientific studies related to patients’ health needs
PBLI2 F1. Seek, reflect on, and respond to one’s own performance data, and recognize and reflect on personal biases, identity, and privilege that can influence interactions	PBLI2 F2. Critically reflect on one's own performance to identify strengths and challenges, reflect on and address the impact that personal biases, identity, and privilege have on interactions, set individual learning and improvement goals, and engage in learning activities to meet those goals	PBLI2 (graduation). Critically reflect on one's own performance to identify strengths and challenges; reflect on and address the impact that personal biases, identity, and privilege have on interactions and decision-making; set learning and improvement goals; and engage in learning activities that address one’s gaps in knowledge, skills, and/or attitudes
PBLI3 F1. Employ strategies for seeking, receiving, acting upon, and delivering feedback as a member of a classroom, research, project, or clinical workplace team	PBLI3 F2. Employ strategies for seeking, receiving, acting upon, and delivering feedback in professional settings	PBLI3 (graduation). Employ strategies for seeking, receiving, acting upon, and delivering feedback, and contribute to a culture of openness to and appreciation of feedback

Interpersonal and Communications Skills

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
ICS1 F1. Communicate with patients, families, peers, and other team members of diverse backgrounds, languages, cultures, and communities using strategies that build rapport and promote inclusion and equity	ICS1 F2. Communicate effectively with patients, families, peers, and other team members of diverse backgrounds, languages, cultures, and communities using strategies to build therapeutic alliances, promote inclusion and equity, and ensure understanding	ICS1 (graduation). Communicate effectively in interpersonal and electronic communications with patients, families, peers, and other team members of diverse backgrounds, languages, cultures, and communities using strategies to build alliances, promote inclusion and equity, and ensure patient, peer, or other team members’ understanding
ICS2 F1. Participate in discussion of sensitive and difficult topics with patients and families under direction of supervisors	ICS2 F2. Discuss challenging information (eg, breaking bad news, negotiating complex discharge plans or end-of-life care issues) with patients and families under direction of the healthcare team	ICS2 (graduation). Demonstrate sensitivity, honesty, and compassion in difficult conversations with patients and families
ICS3 F1. Demonstrate effective listening skills to elicit patients’ concerns and preferences and begin to share management plans in simple cases	ICS3 F2. Share information with patients and families, and elicit and incorporate their concerns, needs, and preferences into management plans	ICS3 (graduation). Share and elicit information and negotiate management plans using shared decision making with patients and their families
ICS4 F1. Demonstrate awareness of one’s own and others’ emotional and behavioral cues	ICS4 F2. Anticipate, interpret, and respond to one's own and other people's emotions appropriately	ICS4 (graduation). Anticipate, interpret, and respond to one’s own and others’ emotions to manage interpersonal interactions effectively

Professionalism

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
Pro1 F1. Form relationships demonstrating sensitivity, humility, and responsiveness to how others define their culture and other aspects of diversity and identity, including but not limited to: race/ethnicity, age, socioeconomic status, gender, gender identity, sexual orientation, spirituality, language, health literacy, and disabilities	Pro1 F2. Demonstrate sensitivity and responsiveness to how patients define their culture, race/ethnicity, age, socioeconomic status, gender, gender identity, sexual orientation, spirituality, disabilities, and other aspects of diversity and identity	Pro1 (graduation). Form relationships with patients, families, and colleagues that demonstrate sensitivity and responsiveness to how others define their culture, race/ethnicity, age, socioeconomic status, gender, gender identity, sexual orientation, religion, spirituality, disabilities, and other aspects of diversity and identity
Pro2 F1. Demonstrate respect, compassion, honesty, and integrity when interacting with patients, families, colleagues, and teams	Pro2 F2. Demonstrate respect, compassion, honesty, and integrity when interacting with patients, families, colleagues, and teams	Pro2 (graduation). Demonstrate respect, compassion, honesty, and integrity when interacting with patients, families, colleagues, and teams
Pro3 F1. Recognize when the needs of others diverge from one's own needs, and develop strategies to balance these	Pro3 F2. Balance the needs of others (eg, patient, patient care, healthcare team) with one’s own needs	Pro3 (graduation). Balance the needs of patients and healthcare team with one's own needs
Pro4 F1. Understand one's role and seek supervision and feedback as needed in small group and clinical settings	Pro4 F2. Navigate the balance of autonomy and need for supervision	Pro4 (graduation). Recognize the need for additional help or supervision and seek it accordingly
Pro5 F1. Demonstrate punctuality and preparedness as well as display professional dress, hygiene, language, demeanor, and behavior during work hours appropriate to the activity	Pro5 F2. Demonstrate accountability and reliability, including initiative, responsiveness, and follow-through, in interactions with patients, families, and colleagues in interpersonal and electronic communications, including electronic health records	Pro5 (graduation). Demonstrate accountability and reliability, including initiative, responsiveness, and follow-through, in interactions with patients, families, and colleagues in interpersonal and electronic communications, including electronic health records
Pro6 F1. Practice ethically with integrity and commitment to social justice, including maintaining patient confidentiality, responding to medical errors and healthcare disparities, respecting patient autonomy, maintaining appropriate boundaries, and using electronic communications, including social media, appropriately	Pro6 F2. Practice ethically with integrity and commitment to social justice, including maintaining patient confidentiality, responding to medical errors and healthcare disparities, respecting patient autonomy, maintaining appropriate boundaries, and using electronic communications, including social media, appropriately	Pro6 (graduation). Practice with a commitment to ethical principles, social justice, and societal needs, including maintaining patient confidentiality, responding to medical errors and healthcare disparities, respecting patient autonomy, maintaining appropriate boundaries, and using electronic communications, including social media, appropriately
Pro7 F1. Adhere to institutional, regulatory, and professional standards and administrative expectations; personal, patient and public safety (infection control, reporting requirements); and professional identification	Pro7 F2. Adhere to institutional, regulatory, and professional standards and administrative expectations; personal, patient and public safety (infection control, reporting requirements); professional identification; and maintaining ethical behavior in research and relationships with industry	Pro7 (graduation). Adhere to institutional, regulatory, and professional standards and administrative expectations; personal, patient, and public safety; adhere to principles of ethical research; and manage conflicts of interest
Pro8 F1. Recognize one's stress and respond appropriately, including using resources to promote wellness and maintain professional behavior	Pro8 F2. Recognize one's stress and respond appropriately, including using resources to promote wellness and maintain professional behavior	Pro8 (graduation). Demonstrate healthy coping mechanisms to respond to stress, including using resources to promote wellness and maintain professional behavior
Pro9 F1. Demonstrate awareness of and reflect on one's professional identity formation as a physician	Pro9 F2. Demonstrate ongoing reflection and learning about one's own professional identity formation	Pro9 (graduation). Demonstrate ongoing commitment to one's own professional identity formation

*Colleagues include: peers, resident and attending supervisors, interprofessional healthcare providers, and staff

Systems-Based Practice

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
SBP1 F1. Contribute to a clinical team in coordinating patient care within or across the healthcare system or community	SBP1 F2. Apply knowledge of the healthcare system to coordinate patient care within and across healthcare systems	SBP1 (graduation). Collaborate to coordinate patient care within and across healthcare systems, including patient hand-offs
SBP2 F1. Demonstrate knowledge of patient safety strategies and contribute to a culture of safety	SBP2 F2. Identify risks to patient safety and apply strategies to deliver safe patient care	SBP2 (graduation). Participate in a systematic approach to promote patient safety
SBP3 F1. Engage in a systems-improvement intervention, using an appropriate framework for identifying needs and proposing systems solutions for panels or populations of patients	SBP3 F2. Incorporate understanding of strategies for promoting healthcare quality in various healthcare systems in generating care plans for patients	SBP3 (graduation). Participate in continuous improvement in a clinical setting, utilizing a systematic and team-oriented approach to improve the quality and value of care for patients and populations
SBP4 F1. Describe current and historical factors affecting health equity, including structural inequalities in access to and quality of health care	SBP4 (graduation). Understand current and historical factors affecting health equity, including structural inequalities in access to and quality of health care, and apply this understanding to improve patient health	SBP4 (graduation). Apply understanding of current and historical factors affecting health equity, including structural inequalities in access to and quality of health care, to improve the health of patients and communities

Interprofessional Collaboration

Foundations 1 (through December of 2nd year)	Foundations 2 (through December of 3rd year)	Graduate will be able to ... (Graduation Milestone)
IPC1 F1. Incorporate understanding of one's own role and the roles of others (peers, physicians, other health professionals) into interactions in small groups and in the clinical setting	IPC1 F2. Incorporate knowledge of one’s own role in different teams and settings and the roles of other health professionals in providing patient care	IPC1 (graduation). Use the knowledge of one’s own role in different teams and settings and the roles of other health professionals to assess and address the healthcare needs of patients and populations
IPC2 F1. Communicate effectively and respectfully with others (peers, physicians, other health professionals) involved in small groups and in patient care	IPC2 F2. Communicate with other health professionals in a responsive and responsible manner that supports collaborative patient-centered care	IPC2 (graduation). Communicate with other health professionals in a responsive and responsible manner that supports a collaborative approach to the maintenance of health and the treatment of disease in patients and populations
IPC3 F1. Demonstrate respect for the cultures, values, roles, and expertise of other health professionals	IPC3 F2. Demonstrate respect for the cultures, values, roles, and expertise of other health professionals in diverse clinical settings	IPC3 (graduation). Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust

UCSF School of Medicine Competencies (updated August 2017)

*This core set of competencies has been organized based on the competencies adopted by the Accreditation Council for Graduate Medical Education (ACGME).