In Reply: Dr Dewar discusses the important and vital connection between the competencies of knowledge and process improvement at the microsystem level. We agree that they should not be seen as separate, but rather as integrated competencies necessary to deliver high-quality care.1 We focused our Commentary on the importance of up-to-date medical knowledge as an essential component of the quality-of-care calculus, because we are concerned that medical knowledge has been devalued in the current and limited focus on performance measures.
Holmboe ES, Lipner R, Greiner A. Assessing Competencies of Knowledge and Process Improvement—Reply. JAMA. 2008;299(19):2276–2277. doi:10.1001/jama.299.19.2276-b