Medical education and the maintenance of incompetence.

We think of medical education as a process that moves novices from a state of incompetence to one of competence. This paper explores the idea that education may, at times, actually lead to incompetence as a result of over-emphasizing particular discourses that construct what competence is. This paper explores four discourses each with its own terminology and core conceptualizations of competence; each of which creates different roles for students and teachers. No one discourse is ideal and all drive teaching and assessment in particular ways. Sometimes these forms of teaching or assessment may inadvertently foster incompetence. In this paper I argue that, as with medical treatments, medical educators must pay more attention to the side-effects of the discourses that shape medical education.