Competence-based education misses the essence of the medical profession

frameworks may undermine training for true professionalism and highlight how their use challenges the professional status of the medical profession. Hereto, I will bring forward two theoretical arguments, referring to the literature on expert performance and the sociology of professions. In short, there are valid reasons to state that the current competence-based approaches (i) elicit educating for mediocrity instead of excellence and (ii) facilitate the process of deprofessionalization of the medical profession; both being of disservice to the quality of patient care. First, however, I will put the spotlight on potentially the most important argument, because it is empirically based: the competency frameworks’ unintended effects of alienating and disengaging physicians from what it means to be a doctor. Unsurprisingly, many physicians (both faculty and trainees) are not at ease with their professional realities—consisting of interacting complex social phenomena of teaching, learning and taking care of patients—being narrowed down to distinct competencies and measurable behaviours and skills. They may perceive the behaviourist view underlying the competence-based model—to operationalize academic and professional knowledge and skills in prescriptions for behaviour—as an impoverished view of professionalism [3] feeling the inadequacy of the model in capturing the core of professional practice. Physicians experience and oppose, for example, the bureaucratic formats through which competence-based models have found their way into practice. They report feeling overwhelmed by the number of imposed checklists, online assessments and administrative requirements that seem to underappreciate the complexity of clinical and teaching practice [1]. The instrumental approach of ‘signing off’ the professional development of students or residents seems to demoralize both faculty and trainees [4]. It pushes them to hide behind schemes, rules and regulations, instead of encouraging them to assume their profesEssentials