The ZDD in Medical Education

In medical education, students strive to become competent, reflective practicing physicians. This ultimate or distal goal requires mastery of six competence areas:

  1. Medical knowledge;
  2. Patient care;
  3. Professionalism;
  4. Interpersonal communications;
  5. Practice-based learning and improvement; and
  6. Systems-based practice.

True mastery occurs over a lifetime and is, perhaps, an ever-expanding zone of distal development. However, there are more proximal goals medical students may achieve in the immediate future and over the course of their four year tenure in medical school.

Curricula should be written to account for this process, expecting students to begin to master basic science and clinical knowledge in preclinical years and to build on that knowledge throughout supervised practice in clinical years.

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