Abstract
<title>Abstract</title> <p> Background As healthcare increasingly evolves into a complex sociotechnical system, clinical decision-making is no longer an individual cognitive task but a dynamic governance process involving patients, families, interprofessional teams, healthcare organizations, and artificial intelligence (AI). Although competency-based medical education (CBME) emphasizes communication, collaboration, professionalism, and reflective practice, existing educational frameworks conceptualize these competencies as parallel attributes rather than explaining how they interact to support high-quality clinical decision-making. This theoretical fragmentation limits the ability of medical education to prepare future clinicians for increasingly complex decision environments. To address this gap, this study introduces the <bold>Medical Decision Governance Competency Theory (MDGCT)</bold> , a novel competency-based educational framework that conceptualizes governance capability as an integrated developmental competency emerging through the progressive interaction of empathy, communication, collaboration, reflective practice, and adaptive problem-solving. Methods A longitudinal mixed-method educational study was conducted among undergraduate medical and nursing students participating in a three-day Dynamic Patient–Physician Communication and Conflict Management Curriculum. Participants completed validated assessments of empathy, communication attitudes, interprofessional collaboration, metacognitive reflection, and adaptive problem-solving at baseline, immediately after the intervention, and during follow-up. Quantitative findings were triangulated with thematic analysis of reflective learning records to examine the theoretical structure proposed by MDGCT. Results The curriculum produced significant improvements across all governance-related competencies, including empathy, communication attitudes, collaboration, reflective practice, and adaptive problem-solving. Although some competencies showed partial attenuation during follow-up, most remained significantly above baseline, indicating sustained educational development. Nursing students demonstrated stronger long-term retention of empathy than medical students. The convergence of longitudinal quantitative outcomes and qualitative reflections provided initial empirical support for the developmental pathway proposed by MDGCT: <bold>Empathy → Communication → Collaboration → Reflective Practice → Adaptive Problem-Solving → Medical Decision Governance</bold> . Conclusions This study extends competency-based medical education by proposing <bold>governance capability</bold> as a distinct educational outcome rather than viewing communication as an isolated professional skill. Medical Decision Governance reframes communication education as the educational foundation for governing complex clinical decisions through the integration of interpersonal, cognitive, collaborative, reflective, and adaptive competencies. Beyond introducing a new competency-based theory, this study establishes a conceptual bridge linking medical education, clinical governance, patient autonomy, shared decision-making, patient safety, and trustworthy AI-enabled healthcare. The findings provide initial empirical evidence supporting governance-oriented education as a new paradigm for preparing healthcare professionals to navigate increasingly complex clinical decision-making environments. </p>