YSM Competencies and Milestones
The Yale School of Medicine (YSM) competencies frame our goals for the knowledge, skills, and attributes that we aim for YSM students to attain prior to graduation. The associated educational program objectives (EPOs) describe the skills and behaviors that are required to achieve each competency.
Below we list our nine competencies. Under each one, we describe the associated EPOs, followed by measurable or observable milestones, which students should demonstrate by the end of each phase of their medical education: pre-clerkship, clerkship, and advanced training period. A more detailed booklet also describes behaviors indicating critical deficiencies for each EPO. Students with critical deficiencies for a particular EPO require additional support and remediation to help them achieve “success.” This assessment tool helps students progress and ensures they graduate with all nine competencies.
On this page
Students apply scientific knowledge and use clinical skills to promote health and prevent disease in individuals and communities.
| EPO Number | Educational Program Objective | Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| HP1.1 | Apply principles of epidemiology and social-behavioral sciences to health promotion and disease prevention for patients and communities. | Demonstrates and applies foundational knowledge in epidemiology and public health to health promotion and disease prevention, including environmental and individual risk factors that may be modifiable. | Applies knowledge of the epidemiologic basis for current health promotion and disease prevention guidelines for each age group. | Demonstrates well-developed knowledge of the epidemiologic basis and public health strategies for health promotion and disease prevention for groups of people based on risk factors, such as but not limited to substance use, viral infection, sex, and genetic predisposition. |
| HP1.2 | Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health, including screening, counseling, immunizations, and chemoprophylaxis. | Demonstrates awareness of HP/DP recommendations and identifies established professional society guidelines regarding such services. Able to talk with a patient about the preventative measures they are aware of and may have used. | Able to review and identify engagement in health promotion and disease and prevention strategies with patients and aid them in modification of risk and in receiving recommended screenings. | Consistently engages patients in discussion about recommended evidence-based health promotion and disease prevention strategies based on individual risk factors. Engages patients in shared decision-making about these decisions. Given the opportunity, tracks provision of these services in a patient panel. |
Students acquire knowledge at the molecular, cellular, organ-system, whole body, and psychosocial levels, and integrate this knowledge with clinical science and skills to diagnose and treat disease.
| EPO Number | Educational Program Objective | Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| MTD2.1 | Apply established and emerging bio-physical, clinical, epidemiologic, and psychosocial scientific principles to the provision of health care for patients, including identification of disease, diagnosis, disease frequency, risk factors, prognosis, and treatment strategies. | Demonstrates an adequate fund of knowledge of mechanisms of disease. Begins to apply knowledge to consider options for treatment of disease. | Demonstrates understanding of mechanisms of disease to the evaluation of patients in clinical settings. Demonstrates increasing understanding of the approaches to diagnosis and treatment of disease. Consistently applies scientific principles to a range of common clinical scenarios. Able to articulate this understanding in oral or written formats. | Demonstrates expanded understanding of scientific principles underlying mechanisms and treatment of disease across medicine and in a selected specialty. Applies expanding understanding to nuanced and complex clinical scenarios. Able to articulate this understanding in oral or written formats. |
Students apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making and clinical problem-solving based on a thorough understanding of the patient's history, physical exam, and diagnostic studies.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| CR3.1 | Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making and clinical problem-solving, based on patient information and preferences and up-to-date scientific evidence while minimizing the impact of cognitive errors. Recognize that uncertainty is part of clinical health care and respond by utilizing appropriate resources. | Using information provided by case scenarios, clinical vignettes, or from a patient (actual or simulated) with a symptom, is able to identify information needed, form questions, assimilate new information and data, and articulate a cognitive process used to develop a basic differential diagnosis. | Consistently identifies main patient problem and considers in context with other key factors (e.g. host, setting). Creates and prioritizes a patient problem list. Incorporates patient history, physical, and paraclinical data to weight diagnostic possibilities. Incorporates patient preference and unique characteristics into diagnostic or therapeutic decision-making. | Demonstrates ability to create a prioritized differential diagnosis. Able to incorporate patient-specific characteristics and patient preferences into more complex diagnostic or therapeutic decision-making. Consistently incorporates concepts of error in diagnostic reasoning using habits of slowing down, checking self for possible cognitive biases (metacognitive processes). |
Students achieve competency in the care of patients at a level required to excel in residency.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| PC4.1 | Gather and interpret essential and accurate information about patients and their conditions through history-taking, physical examination, and paraclinical data (lab studies, imaging, and other tests). | Obtains basic history using a standard rubric using patient-centered techniques. Is able to perform basic components of physical exam with proper technique. | Obtains an organized and accurate history, tailored to the setting. Consistently uses patient-centered and hypothesis-driven questioning. Seeks secondary information sources when appropriate. Performs an exam, using proper technique, in fluid sequence. Correctly identifies and interprets common abnormal findings. | Obtains a logical, accurate, organized, and hypothesis-driven history, integrating patient-centered and doctor-centered questioning. Adapts to different care settings. Seeks and verifies secondary sources of information when appropriate. Performs a hypothesis-driven exam in a fluid sequence. Uses proper technique and identifies, describes, and interprets normal and abnormal findings. |
| PC4.2 | Communicate patient information in an organized and concise manner in both oral and written forms. | Able to present a patient's history of present illness, past medical history, family, and social history, medication list, allergies, and physical exam, and provide brief summary with a rudimentary differential diagnosis. Uses accepted template for written note including the components above. | Delivers a presentation organized around the chief concern. Works to adjust presentation in length and complexity to match situation and receiver of information. Documents an assessment and plan that includes differential diagnosis, problem list, and relevant clinical reasoning. | Filters, synthesizes, and prioritizes information into a concise and organized presentation. Integrates pertinent positives and negatives to support hypothesis. Tailors presentation to situation and receiver. Conveys appropriate self-assurance to put patient at ease. Provides a verifiable, cogent, accurate, timely written narrative that includes institutionally required elements. Includes input from other providers. |
| PC4.3 | Develop and carry out patient management plans in an organized and prioritized manner to promote patient care that is safe, effective, and efficient. Follow up on patient progress. | Is able to construct a thorough problem list in a case scenario, clinical vignette, or with a simulated or real patient encounter. | Constructs relevant, prioritized, problem lists. Offers a plan that explains clinical thinking and reflects guidelines or other literature, for common or uncomplicated problems. Revises approach as new information emerges for uncomplicated cases. Develops processes for efficient time management. | Constructs relevant, prioritized problem lists. Offers sophisticated plans that explain clinical thinking, and reflect guidelines, other literature, controversies, and cost considerations, for more uncommon or complicated patients. Documents shared decision-making with patient. Includes follow up parameters to determine success or untoward effects of plan. Revises approach as new information emerges. Refines processes for efficiency and time management. |
| PC4.4 | Coordinate care with physicians, other health professionals, and health agencies to support the health maintenance and treatment of disease in patients. Make timely, appropriate, and informative referrals or handoffs, ensuring continuity of care through transitions between providers or settings. | Appreciates importance of care coordination within or across the health care system and the roles of other health professionals in the care of patients. Is able to suggest the types of services and expertise that may benefit patients. | Contributes to coordination of care for patients within or across the health care system or community. Under close supervision, may take a lead role. Understands the elements of effective handoffs and may hand off patients under immediate supervision. | Coordinates care within and across health care systems or community. Makes appropriate referrals, providing consultants with specific questions and pertinent information. Handoffs include accurate assessment of patient status, anticipatory guidance, contingencies, and question solicitation. Follows through to ensure safe transitions. |
| PC4.5 | Perform all medical, diagnostic, and surgical procedures considered essential to enter residency in the area of chosen practice. | Understands the anatomic considerations for common procedures; is able to perform basic life support maneuvers. | Understands indications, risks, and benefits for common procedures. Understands elements of informed consent and takes part in these discussions. Under direct supervision, performs common, simple, procedures using proper technique. | Understands the indications, risks, and benefits for wider range of procedures. Under direct supervision, conducts informed consent discussion with patients and families and performs procedures related to selected specialty. Follows up to monitor for complications. |
Students conduct themselves in accordance with professional standards in interactions with patients, families, peers, and colleagues. They learn to prioritize patients’ needs and interests, avoid conflicts of interest, keep current with evolving science and practice standards, defer to ethical principles in difficult decision-making, and engage in self-awareness and self-care.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| PR5.1 | Engage in practices that benefit mental and physical wellness. Cultivate self-awareness to guide appropriate self-care. Recognize stressful situations and explore coping mechanisms best suited for them. Aware of range of support services and reach out for help when needed. Recognize distress in others and offer assistance. | Is able to self-reflect on individual needs and accesses resources available for support for emotional, learning, physical, or other issues. Demonstrates empathy to classmates and offers assistance when appropriate. | Has established resources and routines for self-care; readily accesses. Demonstrates healthy coping mechanisms to respond to stress, including using resources to promote wellness and maintain professional behavior. Uses flex time appropriately. | Has established resources and routines for self-care; readily accesses. Models healthy coping mechanisms to respond to stress, including using resources to promote wellness and maintain professional behavior. |
| PR5.2 | Maintain commitment to lifelong learning. Identify and perform learning activities that address strengths, deficiencies, and limits in knowledge and expertise. Set learning and improvement goals and incorporate feedback into daily practice. | Self-assesses and reflects on feedback with coaches/advisors to monitor progress and develop strategies to reach milestones and attain competency. | Takes individual responsibility for learning. Routinely asks for and incorporates feedback. Routinely self-assesses in competency domains and collaborates to set goals based on self-assessment and feedback by supervisors. | Takes individual responsibility for learning. Routinely asks for and incorporates feedback, able to effectively provide constructive feedback to others. Routinely self-assesses in competency domains and collaborates to set goals based on self-assessment and feedback by supervisors. |
| PR5.3 | Work effectively as an accountable team member to enhance team functioning, the learning environment, and/or the health care setting. Contribute to a culture of psychological safety rooted in mutual respect and trust. | Completes pre-reading and other preparation activities before interactive sessions; effectively participates in small group and other team-based learning activities; respectful and welcoming of member input to foster an environment of inclusion. Responsive to team members' needs. | Routinely on time and prepared for patient care and learning activities; helps other team members with clinical tasks or teaching as asked; respects questions, efforts, and input of others and fosters interprofessional relationships and an environment of inclusivity and support in clinical settings. | Routinely accountable for all clinical team activities; models interprofessional awareness and collaboration; seeks opportunities to create respectful climate; recognizes when help is needed by team members and others and offers assistance; teaches and encourages other learners; consistent upstander. |
| PR5.4 | Demonstrate honesty, responsiveness, integrity, and respect to patients, society, and the profession. Manage conflict between personal and professional responsibilities. Practice flexibility and maturity in adjusting to change with the capacity to alter one's behavior. | Meets administrative deadlines without reminders; responds to direct communications from faculty and staff; completes course evaluations; notifies small group leaders when they will not be attending a session; adheres to the attendance policies; notifies the dean/advisor/course director of personal emergencies or provides adequate advanced notice for planned, excused absences; balances personal and professional responsibilities with assistance as needed. | Routinely and respectfully notifies team of any planned or unexpected absences; is honest with colleagues, team members, and patients about mistakes, uncertainty, and gaps in knowledge; is responsive to requests from patients, staff, and team members; demonstrates flexibility and responsiveness in face of change. Identifies challenges between personal and professional responsibilities and develops strategies to deal with them. | Plans schedule to minimize absences from clinical rotations and Capstone course. Plans coverage for patients under their care if there are unplanned absences from clinical services; transparently seeks to ameliorate and correct mistakes; anticipates and is proactive in responding to needs of patients, staff, and team members; manages professional responsibilities with greater ease. |
| PR5.5 | Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including committing to uphold relevant laws, policies, and regulations which promote patient privacy and autonomy. | Is able to identify ethical principles and consider how they apply to clinical scenarios and case vignettes. | Adheres to ethical principles in clinical settings; respects patient privacy. | Recognizes nuanced ethical dilemmas and has framework to address these; utilizes resources to support clinicians and patients in the setting of ethically challenging situations. |
Students communicate effectively, respectfully, and compassionately in all of their professional interactions.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| CM6.1 | Communicate effectively using patient-centered techniques, with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds. Demonstrate sensitivity, honesty, and compassion in serious conversations, including those about death, end-of-life, adverse events, bad news, disclosure of errors, and other sensitive topics. | Is able to demonstrate patient-centered interviewing techniques with simulated participants and real patients in introductory clinical settings (ILCE/MCE). | Consistently utilizes patient-centered interviewing; incorporates patient preferences and demonstrates empathy, compassion, and cultural sensitivity during clinical care. | Demonstrates consistent patient-centered communication; demonstrates ability to lead serious conversations including goals of care and serious news using published frameworks. Demonstrates sensitive, honesty, and compassion in serious conversations, including those about death, end-of-life, adverse events, bad news, disclosure of errors, and other sensitive topics. |
| CM6.2 | Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making. | Begins to recognizes the ambiguity that is present in many clinical scenarios and is able to articulate the elements of shared decision-making; considers the roles that personal values and circumstances play in patients' decision and the importance of being aware of our own biases during shared decision-making. | Provides information to patients in language they can understand; demonstrates use of shared decision-making behaviors in common clinical scenarios, elicits patient values, and incorporates patient preferences. Is aware of and avoids inserting personal values and preferences. Documents shared decision-making with patient. | Demonstrates use of shared decision-making behaviors in complex clinical scenarios and is able to take the lead in shared decision-making conversations with patients and families from diverse backgrounds. Is aware of and avoids inserting personal values and preferences. Thoroughly documents shared decision-making with patients who have chosen alternative treatment paths, when appropriate. |
| CM6.3 | Communicate effectively and respectfully with peers, staff, interprofessional colleagues, and faculty in classroom, clinical, and administrative domains. | Demonstrates effective interactions with peers, staff, and faculty in small group, classroom, and research settings, including active listening, respectful and honest communication, ability to ask and answer questions, and willingness to receive feedback. | Demonstrates effective interactions with peers, interprofessional team members, residents, fellows, attendings, and staff in clinical settings, characterized by active listening, respectful and honest communication, ability to ask and answer questions during rounds and other educational sessions. Willing to assume leadership position if asked. | Demonstrates effective interactions with peers, interprofessional team members, residents, fellows, attendings, and staff in clinical settings, characterized by active listening, respectful and honest communication, ability to ask and answer questions during rounds and other educational sessions. Willing to serve as a leader and encourages others to take lead when appropriate. Supports the success of fellow team members, recognizing their contributions and facilitating during challenging team dynamics. |
Students recognize barriers to achieving health equity and envision ways to reduce barriers with a commitment to improving the quality of care and health of all people.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success | ATP Success |
|---|---|---|---|---|
| RS7.1 | Identify the social and structural determinants of health that impact patients and communities and utilize these in improving care, including assessment of the impact of psychosocial, structural, or cultural influences on health, disease, care-seeking, care adherence, and barriers to and attitudes toward care. | Is able to describe social and structural determinants of health and their impact on patients and communities. | Consistently considers the impact of psychosocial, structural, or cultural influences on health, disease, care-seeking, care-adherence, and barriers to care. | Consistently considers the impact of psychosocial, structural, or cultural influences on health, disease, care-seeking, care-adherence, and barriers to care. Advocates for patients facing psychosocial, cultural, or structural barriers. |
| RS7.2 | Demonstrate sensitivity and responsiveness to diverse patient populations, including but not limited to gender, age, culture, race, religion, disabilities, and sexual orientation and leverage their role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served. | Can identify behaviors through observation of preceptor and other role models that demonstrate sensitivity to diverse patient populations in their ILCE/MCE/Clinical Skills environments. Begins to recognize how personal values and implicit biases can impact on patient care. | Can describe and elicit current and historical factors affecting health equity, among diverse groups and apply this understanding to improve patient health. Demonstrates sensitivity and responsiveness to the needs of all patients. Recognizes personal values and implicit biases potential impact on patient care and other interpersonal relationships. | Applies understanding of current and historical factors affecting health equity among diverse groups to improve the health of patients and communities. Reflects on and addresses the impact that personal biases, identity, and privilege have on interactions and decision-making. |
| RS7.3 | Appreciate the factors that contribute to patient safety and the methods used to approach quality improvement. Participate in identifying system errors and implementing potential solutions. Advocate for quality and equity in patient care and optimal patient care systems. | Recognizes and describes systems in place in clinical settings to optimize patient safety as well as structural or system issues that can lead to disparate patient outcomes. | Able to describe and distinguish between types of safety errors. Identifies and brings patient safety concerns to team. Able to describe high-reliability behaviors. | Consistently uses high-reliability behaviors to minimize error. Actively participates in patient safety and quality exercises including evaluation of structural factors that impede equitable care. Able to describe the PDSA (plan-do-study-act) cycle approach to patient safety. |
| RS7.4 | Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care. | Recognizes factors that contribute to health care costs and the application of cost-effectiveness analysis in guiding clinical decision-making and allocation of resources | Able to describe and access resources for patient-specific diagnostic and treatment costs; considers risks and benefits in choosing diagnostic and therapeutic approaches to individual patient care. | Routinely considers treatment costs, risks, benefits, and incorporates patient preference. Able to use patient decision analysis tools to guide diagnostic and treatment options. |
Students appreciate that unexplained clinical observations can inspire research that advances the practice of medicine. They perform mentored scholarly research culminating in a formal thesis. This project promotes critical thinking, understanding of the scientific method, and contributes to new medical knowledge and practices.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Early ATP Success | Late ATP Success |
|---|---|---|---|---|
| CDK8.1 | Critically evaluate and use literature, databases, and primary sources to develop a strong scientific premise for a research question. Apply the scientific method to ensure robust, reproducible, and unbiased study design. | Able to perform a well-directed literature search to access primary sources which support the framing of a research question. With close supervision from faculty mentor, writes and submits proposal aimed at answering a research question. | With supervision from faculty mentor, develops initial research questions and study design informed by gaps in scientific knowledge and principles of scientific rigor and reproducibility. Incorporates feedback from faculty mentor to improve and refine initial research plan. | With growing independence, develops and refines initial research questions and study design informed by gaps in scientific knowledge and principles of scientific rigor and reproducibility. Recognizes methodologic challenges in study conduct and works with faculty mentor to develop strategies to overcome. Identifies major threats to internal and external validity for the research design and develops plans to mitigate. |
| CDK8.2 |
Rigorously analyze and interpret data using appropriate scientific and statistical methods. Convey research findings in a clear and organized manner and disseminate to communities of interest.
|
With close supervision from faculty mentor, is able to describe both quantitative and qualitative research methods to analyze data and how they might be used in various research designs. Begins to share research plans and early findings with peers and scientific community. | Recognizes and selects appropriate analytic methods for research questions, study designs, and outcomes of interest. Presents scientific findings in a clear and compelling manner. | Able to accurately depict and interpret results of analyses, acknowledging limitations; presents findings to communities of interest; anticipates and responds to questions. Recognizes errors/limitations and works with faculty mentor to rectify. |
| CDK8.3 |
Apply principles of responsible conduct of research to preserve the integrity of the research process and to protect the privacy and rights of research subjects.
|
Understands the principles of responsible conduct of research. Is able to incorporate these principles in a research proposal. | Able to prepare a proposal for review by the Institutional Review Board (IRB) for the responsible conduct of research in human subjects (or Institutional Animal Care and Use Committee for animal research), or able to describe the required steps. | Applies the principles of responsible conduct of research and proactively takes appropriate steps to preserve the integrity of the research process and protect privacy and rights of subjects. |
Students apply existing and evolving scientific literature to inform their care of patients and promote the health of individuals and populations.
| EPO Number | Educational Program Objective
|
Pre-clerkship Success | Clerkship Success> | ATP Success |
|---|---|---|---|---|
| PS9.1 | Acquire, appraise, assimilate, and apply evidence from scientific studies related to patients' health problems. Demonstrate an investigatory and analytic approach to clinical situations. Evaluate the credibility and usability of the spectrum of medical information resources. | Is able to identify a scientific study or studies related to a clinical scenario, case vignette, or patient encounter, appraise the relevance and generalizability of the study, and relate its findings to the scenario or patient. | Seeks out metanalyses, systematic review, or high quality primary resources (e.g. large RCT, comparative effectiveness, epidemiologic and translational studies, and implementation science) to ascertain risk factors and evaluate diagnostic and therapeutic treatment options related to patient care. Asks specific questions in PICO format (patient, intervention, comparison, outcome). Able to identify limitations and biases in published literature. | Acquires evidence through sophisticated searches of credible resources appropriate to the clinical question. Appraises evidence for validity, impact, and usefulness. Applies evidence while considering clinical context and patient preferences. |