Competency in Another Grammar

In the courtyard of our medical school stand two teachers who never take attendance and never dismiss class.

One is Greek. Hippocrates, four metres of him, raised by alumni in 2011, the oath cut into the stone beside him.

One is French. Rodin's Thinker, placed in 1989 by the obstetrician who founded this school, four characters on the plinth: 我思故我在 — I think, therefore I am.

One of them teaches medicine. The other teaches doubt. Our students walk between them every morning, and mostly do not look up.

This page is about what happened when we tried to make them look up — and discovered that the tools for doing so were not in our curriculum committee minutes, but in our own cultural inheritance, and in a school motto that had been waiting fifty-eight years for its moment.

Like yours, our school runs on competencies. Six domains, twenty-one items, weights totalling one hundred, mapped item-by-item onto the AAMC / AACOM / ACGME set of forty-five. Professionalism carries twenty-five points — the largest single share, a deliberate statement of institutional priority.

The framework is correct. It is also, as prose, dead on arrival.

PR4 — Accepts responsibility: punctual and reliable, completes assigned tasks, honest in the face of error, maintains professional demeanour.

That sentence is true. It is also written in a language that cannot reach the person it describes. No medical student in the history of medical education has ever been moved by a rubric row. We had an excellent map, and no reason for anyone to walk.

The usual remedy is to add stories to the curriculum — a narrative medicine elective, a reflective writing block. We tried something narrower and, we think, more interesting: leaving the framework exactly as it is, and changing only the grammar in which it is told.

Chinese martial arts distinguishes 內功 nèigōng — inner power, cultivated invisibly across years, which spectators cannot see — from 外功 wàigōng — outer form, the strike that can be watched and judged. A fighter with only outer form is a performer. A fighter with only inner power never lands a blow. Neither is complete; each feeds the other.

That distinction was already sitting inside the ACGME domains, waiting to be noticed:

Then came the part we did not plan.

Carved above the gate of this university, since 1968, are eight characters that every student walks past and no student reads:

誠以達人 chéng yǐ dá rén — through sincerity, reach others.
樸以潔己 pú yǐ jié jǐ — through simplicity, cleanse oneself. University motto, 1968

The second line is the inner work. The first line is the outer. Our motto had been describing a competency framework for fifty-eight years before we adopted one — and the framework, when it arrived from Chicago and Washington, turned out to be describing the motto.

The three inner virtues and three outer are paired, each inner one discharging into its outer counterpart — 智→仁 (knowledge becomes care), 誠→通 (sincerity becomes communication; an insincere conversation is merely technique), 進→衡 (reflecting on yourself becomes reflecting on the system — which is what quality improvement is).

Literally "rivers and lakes," jiānghú is the world outside the school: where a martial artist actually lives, fights, is judged, and is occasionally rescued by strangers. "The real world" is too flat. "The arena" is too gladiatorial. "The field" is too academic. Ask a Chinese reader for a definition and they will usually decline, and say instead: you'll know it when you're in it.

Our students enter theirs in the fifth year. It has fluorescent lighting and smells of chlorhexidine.

For that page — written for clerks, not preclinical students — the workplace-based assessment system is renamed rather than explained:

The rename is not decoration. It performs a reversal we could not achieve by exhortation:

One further example, because it shows the ethical care this kind of writing demands. Our dashboards are honest about an uncomfortable number: a measurable share of written feedback runs under ten characters. Sometimes it is one character — 可, acceptable.

We could have written a page scolding faculty. We wrote one teaching students a move:

"Doctor — where could I have done better?"
Three seconds to say. In the framework this is LG1, seeks and integrates feedback. In the story it is a technique you acquire because the alternative is a one-character future. from 病房即江湖 — "The Ward Is a Jianghu," chapter II

The obvious objection to everything above is that it is charming and unfalsifiable. We share that worry, so the narrative layer sits on top of an evidential one, and both are public.

Two design rules keep the poetry and the accountability from corrupting each other:

Every virtue name is one click from its official article. Each of the twenty-one items appears in the story pages tagged with its formal code (PC1, MK3, PR4…), and each code links back to the verbatim framework text. A student reads 誠; an accreditor reads PR1–PR5; neither has to take the other's word for it.

Assessment density is disclosed, not hidden. Our own data show that some competencies are assessed eighty times per student and others six. The story says so out loud — "some moves you will be fed eighty times; others you will spar six times in six years, so you must go and ask for them" — because a student who reads a blank square as personal deficiency has been misled by our instrumentation, not by their own ability.

Nothing on this page is a proposal that your school adopt Chinese martial arts. The transferable claim is narrower and, we hope, more useful:

If you want to try this, here is the method we would give a colleague:

1. Find the distinction your framework already contains. Do not invent a metaphor and impose it. Ours split cleanly into inward and outward because that split was genuinely there. Yours may split by time, by risk, by solitude and company. Look before you decide.
2. Look for the sentence your institution has been repeating for decades. A motto, a founder's line, a phrase in the school song. If it survived that long, it is load-bearing. Ours had been describing competency domains since 1968.
3. Leave the untranslatable word untranslated. Explaining why a word cannot be translated is more powerful than a lossy substitute — and it tells the reader they are somewhere specific, not in the generic language of educational administration.
4. Anchor in both directions. Virtue name to official code; official code to virtue name. Poetry without codes cannot survive an accreditation visit; codes without poetry cannot survive a Tuesday morning.
5. Fix the ethical rule before you write the first sentence. Ours: the patient is the teacher, never the level. A martial-arts frame will drift toward opponents and boss fights unless you forbid it in advance. Decide what your frame must never say.
6. Do not gamify what should be read. We designed a badge-collection mechanic across these pages, built it — and cut it. A story that stops every few minutes to award points is no longer a story. The reward for reading is a scroll you may keep, offered once, at the end, with nothing to collect.

Rule six was the hardest, and is the one we would most want a colleague to hear. The pull toward engagement mechanics is strong and it is usually wrong for material of this kind. Silence is a feature.