Introduction

At face value, medical knowledge seems like the most straightforward of the competencies to teach and assess. However, we practice medicine in a time of rapid change with exposure to an overwhelming amount of information. Estimates suggest that the volume of medical knowledge doubles every 6 to 8 years. Physicians must first acquire a basic foundation of medical knowledge through formal education. The assessment of this basic knowledge is accomplished by a series of certifying examinations culminating in a specialties professional board certifying examination. Physicians must also learn, however, to constantly review this expanse of medical literature in an effort to stay up to date with the latest research and technology. While doing this, physicians must learn clinical reasoning and critical thinking skills that allow them not only to remember and understand the knowledge they acquire, but also to apply that knowledge to different clinical situations.

Definition and Importance of Medical Knowledge

Medical knowledge is the clinical information a physician must have to practice medicine competently. But medical knowledge encompasses far more than the basic sciences and the memorization of clinical information. The Accreditation Council for Graduate Medical Education (ACGME) further defines medical knowledge as it relates to residents: “Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and the application of this knowledge to patient care. Residents are expected to: (1) Demonstrate an investigatory and analytic thinking approach to clinical situations and (2) Know and apply the basic and clinically supportive sciences which are appropriate to their discipline.”¹ Thus medical knowledge, in addition to the factual information obtained in study, includes the assessment and evidence-based application of that knowledge through critical thinking skills and clinical reasoning.

There are two main components of medical knowledge described by Rider in A Practical Guide to Teaching and Assessing the ACGME Core Competencies that help in understanding the complex nature of this competency. These are “public knowledge” and “personal knowledge.” Physicians attend medical school courses, read textbooks, take tests and quizzes, participate in didactic lectures, and read journal articles, which all relate to our public knowledge. This public knowledge is, in short, information the medical community has access to. Our personal knowledge is essentially the knowledge that allows a physician to make clinical judgments based on clinical reasoning.² This type of knowledge incorporates both the tangible and intangible information we have accumulated through training. It is the personal charts, note cards, and study material we have from our medical school classes. It is the diagnoses and cases in which we have been intimately involved, whether during core rotations, during residency, or during postresidency clinical practice.

Our professional knowledge, the combination of both public and personal knowledge, is constantly changing, and the process of acquiring and maintaining this knowledge can be overwhelming. We must continue to develop this professional knowledge as we make clinical decisions, as we practice, as we attend continuing medical education opportunities, and as we read and interpret the medical literature.