Clinical Distinction

Your future, by you

Assessment Tools: Describing and Demonstrating Competency Growth

In creating your specialty track course design, you’re developing a curriculum.

Every teacher who develops a curriculum needs to:

  • Know what they want the student to learn (course learning outcomes)
  • Know How they will know the student learned what they hoped they’d be teaching and
  • Provide resources to allow the student to learn.

This page explains how you will self-assess your work and growth.

A Process of Growth Development and Learning

The work (activities) of your clinical distinction course will help you learn and grow. Each of the activities you’ve selected must be aligned with your learning outcomes so that as you complete them the process of growth and learning is revealed.

The Narrative Evaluation

Every student will self-evaluate their competency growth in a Narrative Evaluation form. Self reflection and narrative description may be the one way you describe your competency growth.

Entrustable Professional Activities

Entrustable Professional Activities (EPAs) are a specialized way to describe competency growth. Residency directors understand that entrustment decisions in clinical settings can give them clarity on your level of competence and readiness for residency. Read more about this below.

Final Products

One way to demonstrate increased competence is through a certificate of adequate completion for a course or learning module

Another way is through a final product through which you can demonstrate how you’ve developed yourself and it might take any form… a presentation, a podcast, an essay, a 3-D model. Read more about final products in this blog:

How Will You Demonstrate Increased Competence?

Your contract asks you to think about how your faculty sponsor will evaluate the competence and entrustability you gained. The question on the contract reads:

Describe how the activities and self-assignments you’ve selected will promote the specific competencies and EPAs you selected.  Be sure to name each competency and EPA. You will describe your increased competence in your final evaluation using this response. Will your project allow you to self-evaluate in this way?”

A well-designed contract will describe the expected development in competence over the course of the project. Many students will be able to use entrustable professional activities as an anchor in their discussion. However, not all students will have this option, and for those that don’t a narrative evaluation with language that is focused and specific, regarding their exploration of the competencies which they selected, is important.

Students can describe how the activities afforded them the opportunity to dive into the area of competence they selected and use the AACOM’s Core Competency report to understand and discuss what components of the competency they focused on. In writing about the competencies specifically, students will demonstrate a level of self-reflection and understanding of professional development which will highlight their capacity for being a medical professional and a successful intern.

In your first two years you took multiple choice tests to demonstrate certain levels of achievement. You also got reviews from your peers. In Clinical Distinction it’s up to you to decide how you and your sponsor will know that your competency increased.

Showing Increased Competence

It might seem intuitive that certain activities will result in increased competency – for example, if you read Harrison’s Internal Medicine, you should have an increase in medical knowledge competence. If you work with patients you might increase your patient care competence.

But when you are planning your project ask this question:

“How will my sponsor know that my competency increased?


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However you demonstrate competence, focusing on this shows potential residency directors you understand what you need to do to be the kind of resident they are looking for.

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Criteria for passing are different then learning outcomes. When you complete your contract you’ll be asked about these things separately.

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Even though many activities allow learning in all or most of the core competencies, the student’s task is to select 1-4 competencies on which they will focus. It’s about quality, not quantity and allows students to describe an authentic and specific process of growth.