Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


Medical Education


Dr. Dipu Patel


Practice-based learning and improvement (PBLI) is a core competency of the Accreditation Council for Graduate Medical Education (ACGME).1 This competency can be described as a medical provider’s ability to assess their own performance (or accept the assessment of experts), stay current with medical literature, and become a lifelong learner and educator. The Physician Assistant Education Association (PAEA) has a similar domain for new physician assistant (PA) graduates called Self-Assessment and Ongoing Professional Development.2 This domain is described as “competent graduates…[who] demonstrate an awareness of their personal and professional limitations and develop plans and interventions for addressing gaps”2(p6) Under PAEA’s schema, this domain is cross-cutting, meaning that it should be applied to all other domains: patient-centered practice knowledge, society and population health, health literacy and communication, interprofessional collaborative practice and leadership, professional and legal aspects of health care, and health care finance and systems. Practice-based learning and improvement is commonly thought of as completing continuing medical education and reviewing scientific literature, the first easy to obtain and the second teachable. While these are part of PBLI, the underlying crux of most problems involving this domain are related to a lack of acceptance of both life-long assessment and improvement (including the self as a capable assessor, i.e. metacognition) and the willingness to engage in the process. Lapses in PBLI are attributed to many reasons: lack of metacognition, refusal to admit fault, embarrassment at making mistakes, overconfidence, and/or over-reliance on peers.3 Researchers continue to study PBLI, especially where it concerns the giving and receiving of feedback, and how it can help ameliorate poor performance in this competency.


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