During the past decade, medical educators have spent time discussing and attempting to define medical competence. There appears to be some confusion as to why definitions of competence are important and how one might describe in a logical fashion the elements of competence for physicians. Here, we try to clarify what is meant by competence, to describe how definitions of competence are of value to students, educators, institutions and the public, and to provide a conceptualization of the elements of a definition of competence in medicine.