Competency in the new language of medical education.

The chances are that, even within the past week, you have been involved in some discussion of competence. As concepts and as terms, ‘‘competence’’ and ‘‘competency’’ have crept into everyday medical vocabulary to a point where it is difficult to determine how, when and why they first appeared. This is a real problem, given the importance that has been placed upon ‘‘competency’’ in what I call the ‘‘New Language’’ of medical education. How can we even begin to decide on the value of ‘‘competencies’’ if we don’t even know what they are, what they really represent, or what they were first designed to be? I want to take a step back to look at the roots of ‘‘competence’’, discuss some very real issues in its current usage and propose a new model of terminology which better reflects what we should be aiming for in our teaching and assessment of clinical practice.