Doctors must possess the professional ability, often referred to as “competence as a physician,” to perform their duties effectively. In Korea, this competence is recognized through a medical licensing system that grants exclusive authority for medical treatment to doctors who meet specific qualifications and competencies. The strict qualification requirements for medical practitioners stem from the critical need for doctors to treat patients safely and appropriately. Therefore, modern medical education has evolved from a lecture-based approach to one that emphasizes competency-based and performance-based education [1]. The concept of “entrustable professional activities” (EPA) has recently been introduced in medical education to reflect the need for physicians to be able to perform their professional duties independently without supervision [2,3]. In response, the medical education and training system has restructured its curriculum to provide medical students and specialists with the necessary competencies at various stages of their careers, including ongoing education for specialists. Within this framework, defining doctors’ competencies has become the cornerstone of medical education and training. Competencies are also important insofar as they enable physicians to understand and shape their self-identity based on their professional actions.

The Oxford Dictionary defines competence as “the ability to do something successfully and efficiently” [4]. The U.S. Office of Personnel Management defines competency as “a measurable pattern of knowledge, skills, abilities, behaviors, and other characteristics that an individual needs to perform work roles or occupational functions successfully.” These competencies “specify the ‘how’ of performing job tasks, or what the person needs to do the job successfully” [5]. Carraccio et al. [6] defined a physician’s competency as “a complex set of behaviors built on the components of knowledge, skills, and attitudes” and distinguished competence as a physician’s “personal ability” [6]. These two words—“competence” and “competency”—are generally used without a clear distinction in meaning, so in this paper, we will use “competency” uniformly according to the usage in Canadian Medical Education Directions for Specialists (CanMEDS). Whitcomb [7] stated that for a physician “to be competent” means that “they are able to provide medical care and/or other professional services in accord with practice standards established by members of the profession and in ways that conform to the expectations of society.” Frank [8] defined competencies as “important observable knowledge, skills and attitudes” and “The Council on Linkages between Academia and Public Health Practice” defined core competencies for physicians as “a consensus set of knowledge and skills for the broad practice of public health” [9].

Since the 1990s, several countries have begun to define doctors’ competencies within their borders and to specify their components [10]. After the World Federation for Medical Education (WFME) recommended that countries identify and enact a future role for doctors as part of the project on the future global role of the doctor in healthcare in 2012 [11] (Appendix 1), this initiative gained momentum in many countries. Comparing the competencies developed in various countries reveals that they are largely similar. However, the way these details are organized into categories, or core competencies, differs from country to country. The most commonly referenced doctors’ competency frameworks around the world are as follows. CanMEDS 2015, a Canadian doctors’ competency framework, organizes physician competencies into seven roles centered on the physician’s function [12]: medical expert, communicator, collaborator, leader, health advocate, scholar, and professional. The United Kingdom’s “Good Medical Practice” from 2020 organizes physician competencies into four core areas: knowledge, skill, and performance; safety and quality; communication, partnership and teamwork; and maintaining trust [13]. The Accreditation Council for Graduate Medical Education (ACGME) in the United States (U.S.) categorizes physician competencies into six domains [14]: patient care, professionalism, interpersonal and communication skills, medical knowledge, systems-based practice, and practice-based learning and improvement. Notably, the U.S. framework includes “systems-based practice” as a core competency for doctors, which is not explicitly found in the Canadian and U.K. frameworks. This competency involves understanding how a physician’s practice impacts and is influenced by the broader health and social systems, including working within various healthcare delivery systems and public health settings; coordinating patient care; recognizing healthcare costs and conducting risk-benefit analyses; improving patient care quality and optimizing healthcare systems; collaborating in interprofessional teams to enhance care quality and safety; and participating in the identification of system failures. While elements of “systems-based practice” can be found in other countries’ doctors’ competency frameworks, its explicit inclusion and emphasis as a core competency reflects the priorities in American medical education and residency training in the context of the U.S. healthcare system.

In Korea, the first study on doctors’ competencies was conducted in 2007 as part of “Development of a Common Curriculum for Post-Graduation Education for Residents,” which was a policy task of the Korean Institute of Medical Education and Evaluation [15]. In 2010, in honor of the 100th anniversary of the graduation of licensed physicians, the Research Institute for Healthcare Policy and the Korean Medical Association published the “Report on the Development of a Common Curriculum for Residency in Korea” to establish the identity for residency education in Korea [16]. Subsequently, the Korean Academy of Medical Sciences conducted a policy study in 2013 for the Ministry of Health and Welfare titled “Study on Reorganization of Training Curriculum by Specialty Subject for Efficient Training of Residents.” This study proposed a set of general educational competencies for residents in Korea, drawing from the Korean RESPECT 100 competencies, the ACGME’s six core competencies, the seven roles of CanMEDS in Canada, and the four competencies of the General Medical Council’s Good Medical Practice in the United Kingdom [17]. Accordingly, most of these competencies were subsequently incorporated into the Ministry of Health and Welfare’s annual training curriculum for residents, announced in February 2019 [18]. In 2014, the “Korean Doctor’s Role” was created and published [19]; it was endorsed by the Korean Council on Medical Education and served as a guideline for medical education and residency training, continuing education, and competency development research. This framework was subsequently revised and updated in 2021 to become the “Korean Doctor’s Role 2022” [20]. As the title implies, it outlines the qualities of an ideal doctor within the Korean context, with an emphasis on the competencies required for medical practitioners. Both the 2014 and 2022 editions of the “Korean Doctor’s Role” were organized into five main categories: patient care, communicator & collaborator, social accountability, professionalism, and education and research. Compared to other countries, the “Korean Doctor’s Role” is distinctive in its focus on the attributes of medical practice. Subsequent studies have aimed to establish milestones EPAs based on the “Korean Doctor’s Role (2014)” [21,22]. However, there have been several suggestions for improving the “Korean Doctor’s Role” for use as a competency framework, including concerns that some competencies resemble milestones associated with specialty acquisition rather than ongoing competencies, that there is redundancy among the competencies, and that the framework includes physician attitudes and behaviors that are challenging to define clearly.

Doctors’ competencies are not set in stone once and for all. Even in international contexts, we can observe that the competencies required of doctors have evolved over time. For instance, in the United States, the ACGME initially referred to the six competencies as the “general competencies” at the outset of the ACGME Outcome Project in 1999. However, following the first revision in 2002, the term “core competencies” began to be used interchangeably, and the underlying concept was modified [23]. In 2005, the organization considered introducing the next accreditation system, and in 2013, it launched the so-called milestone competency-based curriculum, which further subdivides the competency-based curriculum and defines each competency level [24]. Similarly, the Canadian CanMEDS framework has undergone regular revisions since the release of CanMEDS 2000, including updates in CanMEDS 2005 and CanMEDS 2015. In the CanMEDS 2015 iteration, the role of the physician, previously termed “manager,” was redefined as “leader,” among other changes, culminating in the “Draft CanMEDS 2015 Milestones Guide (CanMEDS milestones)” [25]. The CanMEDS milestones systematically define competencies from the point of medical licensure to the most advanced mastery stage post-specialization. They delineate graduation competencies for each level, including competencies at the time of obtaining a medical license, competencies at the time of graduating from the Royal College examination, competencies at the time of obtaining a specialty license, and competencies at the stage of lifelong professional development, which is considered the most advanced in terms of a continuous competency development system. Thus, it is clear that the competency framework for doctors is continually being researched and updated to align with the evolving demands and needs of the times.

This study was conducted as an in-depth research topic within the scope of the “Research on Improving Resident Education System for Patient-Centered Performance,” which is part of the “Patient-Centered Medical Technology Optimization Research Project” sponsored by the National Evidence-based Healthcare Collaborating Agency in 2020. The goal was to overhaul the resident training system for specialty doctors, transitioning to a new competency-based, performance-oriented framework. To effectively evaluate this revamped training system, it is essential to first define the competencies required of Korean doctors, including residents. This will enable the establishment of specific milestones and EPAs for each stage of training. Therefore, this study aimed to fulfill the following objectives, while also enhancing the “Korean Doctor’s Role” as a foundational competency framework for physicians.

First, we aimed to develop a competency framework tailored to the Korean context, which would facilitate the identification of educational and training milestones at each stage. We approached the development of doctors’ continuing education as a continuous progression. The concept of milestones is predicated on the understanding that the competencies required of doctors evolve over different times and stages, akin to a child’s development. It is therefore crucial to delineate the acquisition of skills and knowledge at each level and to devise a system that enables incremental observation and feedback on the competencies acquired by medical residents through milestone evaluations. Our study aimed to establish a foundational competency structure for physicians and to introduce a competency framework for doctors, upon which milestones can be set for each phase, including graduation from medical school, residency, specialty training, and ongoing professional development. This will facilitate the creation of a competency framework for doctors that is teachable, measurable, and more effectively aligned with their successive stages of development.

Second, we aimed to develop physicians’ competencies from a patient-centered perspective. Existing competency frameworks have predominantly been crafted by medical educators and physicians with considerable expertise in this domain. While this approach was necessary to ensure that the frameworks accurately represented the medical context and educational methodologies, it inadvertently introduced limitations by not adequately incorporating the perspectives and opinions of patients or the broader medical community. To address this gap, our study gathered insights on physicians’ competencies from a diverse group of stakeholders, including the general public and nurses. Additionally, we sought input from a range of medical professionals, including medical educators, medical school professors, salaried and self-employed physicians, residents, and medical students.

This study was approved by the Institutional Review Board of Chungnam National University Hospital (CNUH 2021-02-025).

The core “Korean patient-centered doctor’s competencies,” as derived from this study, consist of six subject-oriented competencies for physicians. First, as experts, doctors possess competencies related to disease and health. Second, in their role as communicators, doctors have competencies that facilitate interactions with patients. Third, as collaborators, doctors exhibit competencies in working with their colleagues. Fourth, doctors acting as healthcare leaders demonstrate competencies that serve society. Fifth, as professionals, doctors maintain competencies that pertain to their own conduct. Sixth, as scholars contributing to the advancement of medicine, doctors are expected to possess competencies related to scholarly activities.

The competency framework is structured hierarchically, comprising core competencies, sub-competencies, and practical competencies, as detailed in Appendix 2. The core competencies are described below.

The development process of the Korean patient-centered doctor’s competencies and the resulting competency framework can be summarized as follows.

First, the core competencies were categorized as subject-oriented. In the past, competency structures for doctors created internationally have centered on the roles of doctors, such as CanMEDS in Canada, on the areas of doctors’ activities, such as ACGME 6 Competencies in the United States, or on the features of their activities, such as Good Medical Practice in the United Kingdom. Each of these has its own merits. However, the competency structure of this study organizes the competencies into a “subject-oriented” competency framework. It aims at ensuring clarity and convenience in medical education and training, and is intended to create patient-centered medical competencies. For example, a physician’s competency of “communication” appears in all domestic and international physician competency contents. CanMEDS in Canada also includes the role of a communicator as one of the seven role competencies. The term “communication” encompasses a wide range of interactions, not only with patients but also with colleagues and society at large. This breadth can make it challenging for medical students and trainees to grasp the specifics of their communication responsibilities, leading to potential confusion in both teaching and assessing these competencies at various stages of development. To address this, the patient-centered physician competency framework developed in this study emphasizes the importance of the physician’s communicative role, particularly with patients. This focus helps medical students, residents, and specialists understand that their primary communication responsibility is toward patients and their advocates. To maintain this clarity, competencies related to interactions with colleagues and society are integrated into the core competencies of collaboration and societal leadership, which are ultimately realized through effective communication. The research team is confident that the benefits of structuring core competencies in this “subject-oriented” manner surpass any potential drawbacks.

Second, the Korean patient-centered doctor’s competency framework is specifically comprised of competencies that are teachable and assessable, which is advantageous for residency training. It includes only those competencies deemed essential for medical students, residents, and specialists. This specificity facilitates the establishment of clear milestones and EPAs, enabling the monitoring of competency development. Competencies that are abstract or conceptual, and thus challenging to evaluate, are intentionally omitted. As a result, the framework is tailored for practical application within the residency training of various clinical specialties.

Third, multiple development methods were used to construct the patient-centered competencies. In order to ensure that these competencies are truly patient-centered, we systematically conducted a survey to gather the competencies of doctors as mentioned by citizens on social media, in newspaper articles, and in domestic and international research articles pertaining to medical education. This was complemented by discussions within a research team of medical education experts and Delphi surveys. A distinctive feature of our approach was the incorporation of perspectives from a broad range of stakeholders, including citizens, nurses, medical students, residents, and specialists. This group of specialists encompassed salaried doctors, self-employed practitioners, and university professors, all of whom contributed their views on the competencies required of doctors through surveys. This method of creating a competency framework for doctors is internationally novel and may serve as a template for other nations looking to develop their own frameworks for doctor competencies in the future.

In conclusion, this study has proposed a patient-centered doctor’s competency framework, delineating “subject-oriented” core competencies, sub-competencies, and practical competencies. The anticipated next steps are as follows:

First, milestones should be established for each stage of physician education based on the proposed competencies. Specifically, milestones for each competency need to be set at four critical junctures: upon graduation from medical school (entry into residency training), completion of residency training (entry into specialty practice), completion of specialty training (acquisition of specialty certification), and throughout lifelong professional development. Additionally, EPAs should be defined for each stage in alignment with these milestones.

Second, based on the established milestones and EPAs, it will be necessary to establish standards for designing, implementing, and evaluating key curricula for each educational and training period. It is anticipated that this approach will lead to the creation of a seamless educational system, facilitating the delivery of education and training from the basic medical curriculum through to residency, specialty training, and lifelong professional development.

The expectations and awareness of healthcare from the public and patients are changing, as are the needs of the state and society regarding the healthcare system. Concurrently, advancements in science and medical technology occur daily. The perspectives of residents, specialists, and medical students on the role of medicine and physicians are rapidly shifting. Consequently, the competencies required of doctors must also be adapted. In this context, the development of the Korean patient-centered doctor’s competencies represents the Korean medical community’s effort to address these changes. As discussions and evaluations of various opinions and ideas persist, it becomes a crucial social responsibility for those currently overseeing medical education and training to enhance its effectiveness, efficiency, and balance. This is particularly important for medical students and residents who are on the path to becoming future medical professionals. Therefore, it is anticipated that the organization of doctors’ competencies will continue to be refined in the future.