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Table 2 Example of one of the 15 science of health care delivery sub-competencies with associated milestones

From: Science of health care delivery milestones for undergraduate medical education

Individualizes care by engaging patients in shared decision making and motivating behavior change
Level 1 Level 2 Level 3 Level 4 Level 5
Uses directive style of guiding patient decisions Respects patient autonomy in healthcare decisions
Discusses potential challenges associated with integrating patient values and beliefs with those of self, society, and the core values of medicine
Recognizes opportunities for shared decision making Engages patients in shared decision making Develops care plans jointly with patients and caregivers
Uses technical terms and jargon   Uses easy-to-understand language in all phases of communication Assesses patient understanding of health information and invites questions Consistently demonstrates communication strategies to ensure patient understanding and matches communication modality to the patient needs, health literacy and context
Conducts interview without inquiring about social and behavioral factors that affect the health of individuals Identifies social and behavioral factors that affect the health of individuals and may be modifiable Describes effective approaches to modifying individual health behaviors, such as shared decision making aids, motivational interviewing and health behavior coaching Implements decision aids, motivational interviewing and/or health behavior coaching to modify individual health behaviors for patients who are motivated to change Adapts decision aids and health behavior coaching techniques for patients who are not motivated to change
aRepresentative Corresponding ACGME Milestones [23]
Derm ICS1 Aero Med MK1, FM ICS1, TY Prof2, Occ Med MK1 Aero Med MK1, Occ Med MK1, Prev MK1, Psych ICS2, Derm ICS1, FM ICS2 Aero Med MK1, FM ICS2, Oph ICS1, Occ Med MK1, Prev MK1, Psych ICS2, Uro ICS2, IM ICS1 Aero Med MK1, FM ICS2, Neuro ICS, Occ Med MK1, Peds SBP1, Prev MK1, Psych ICS2 & Prof1,PS Prof1
  1. aReferenced milestones are representative, not comprehensive. Reference Milestone Abbreviations: GME Graduate medical education, ICS interpersonal and communication skills, MK medical knowledge, Prof professionalism, SBP systems-based practice. Specialty Abbreviations: Aero Med aerospace medicine, FM family medicine, Neuro neurology, Occ Med occupational medicine, Oph ophthalmology, Peds pediatrics, PS plastic surgery, preventative/public health, Psych psychiatry, TY transitional year, Uro urology