Open Access Open Badges Research article

Promoting medical students’ reflection on competencies to advance a global health equities curriculum

Patricia B Mullan1*, Joy Williams2, Preeti N Malani3, Michelle Riba4, Andrew Haig5, Julie Perry6, Joseph C Kolars3, Rajesh Mangrulkar3 and Brent Williams3

Author Affiliations

1 Department of Medical Education, University of Michigan Medical School, Ann Arbor, USA

2 Department of Family Medicine, University of Michigan, Ann Arbor, USA

3 Department of Internal Medicine, University of Michigan, Ann Arbor, USA

4 Department of Psychiatry, University of Michigan, Ann Arbor, USA

5 Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, USA

6 Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, USA

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BMC Medical Education 2014, 14:91  doi:10.1186/1472-6920-14-91

Published: 3 May 2014



The move to frame medical education in terms of competencies – the extent to which trainees “can do” a professional responsibility - is congruent with calls for accountability in medical education. However, the focus on competencies might be a poor fit with curricula intended to prepare students for responsibilities not emphasized in traditional medical education. This study examines an innovative approach to the use of potential competency expectations related to advancing global health equity to promote students’ reflections and to inform curriculum development.


In 2012, 32 medical students were admitted into a newly developed Global Health and Disparities (GHD) Path of Excellence. The GHD program takes the form of mentored co-curricular activities built around defined competencies related to professional development and leadership skills intended to ameliorate health disparities in medically underserved settings, both domestically and globally. Students reviewed the GHD competencies from two perspectives: a) their ability to perform the identified competencies that they perceived themselves as holding as they began the GHD program and b) the extent to which they perceived that their future career would require these responsibilities. For both sets of assessments the response scale ranged from “Strongly Disagree” to “Strongly Agree.” Wilcoxon’s paired T-tests compared individual students’ ordinal rating of their current level of ability to their perceived need for competence that they anticipated their careers would require. Statistical significance was set at p < .01.


Students’ ratings ranged from “strongly disagree” to “strongly agree” that they could perform the defined GHD-related competencies. However, on most competencies, at least 50 % of students indicated that the stated competencies were beyond their present ability level. For each competency, the results of Wilcoxon paired T-tests indicate – at statistically significant levels - that students perceive more need in their careers for GHD-program defined competencies than they currently possess.


This study suggests congruence between student and program perceptions of the scope of practice required for GHD. Students report the need for enhanced skill levels in the careers they anticipate. This approach to formulating and reflecting on competencies will guide the program’s design of learning experiences aligned with students’ career goals.

Global health; Disparities; Medical education; Assessment; Reflection; Curriculum development