Competency-Based Education

The construct of competence in health care links educational providers, certifying bodies, and employers in the common goal of developing an effective health care workforce. Competency-based education (CBE) has been the educational intervention of choice of many professional and technical health programs. CBE is seen as increasing activities within the classroom that reflect the actual workplace and challenges the idea that institutional reputation determines the quality and competence of graduates (Calhoun, Wrobel & Finnegan, 2011). Many advocates of CBE in health education today suggest the competency-based approach better serves patient needs while providing accountability for public funding because CBE ensures formal education effectively bridges into practice (Hoge, Huey & O’Connell, 2004). 

Behavioral Learning Theory

CBE resides in behavioral learning theory, which resides in the epistemology of objectivism. The central argument of behaviorism is that the internal processes of the mind are irrelevant and “the self is reducible to publically accessible behavior” (Hall, 1979, p. 268). Behaviorism is the study of performance only and it does not address the concepts that the right behavior can result for the wrong reasons, that “fixed actions get varied results” (O’Connor & McDermott, 1997, p. 121), and that the contextual environment might impact an individual’s performance. While this objectivist approach may be appropriate in simple and stable environments, the health care organization today is neither simple nor stable. Some researchers are redefining the health care organization from a mechanistic environment to a complex adaptive system (Holmboe, Sherbing, Long, Swing, & Frank, 2010; Morgan, 2006).

Complex Adaptive Systems

Complex adaptive systems (CAS) contain many diverse, self-organizing components that are interdependent with other components and the environment (Bennet & Bennet, 2004). The CAS may better describe the modern healthcare systems in which each department (a self-organizing component) responds to the emerging patient care needs (other components) within the boundaries of location, clinical care pathways, protocols, and scopes of practice (the environment). The health care team adapts and innovates their person-centred care to support wellness.

The measurement of competence appears to be only a measurement of time in practice

When using a competency-based approach, competence is defined through a series of performance objectives typically contained within a competency profile. In order to enter practice, the novice must demonstrate these performance objectives in the workplace under practitioner observation.

In practice, advocates of the competency-based approach are finding significant limitations empirically demonstrating that competencies can be defined and measured. Instead, research on medical expertise is indicating entry-level and expert practice cannot be differentiated and skills degrade over time (Ericsson, 2007). The differences between entry-level and expert have only reliably been explained through cognitive differences. Therefore, the measurement of competence appears to be only a measurement of time in practice.

References

Bennet, A. & Bennet, D. (2004). Organizational survival in the new world: The intelligent complex adaptive system. Alex Bennet and David Bennet/Elsevier Science: Burlington, MA

Calhoun, J.G., Wrobel, C.A., & Finnegan, J.R. (2011). Current state in U.S. public health competency-based graduate education. Public Health Reviews, 33, 148-167.

Ericsson, K.A. (2007). An expert-performance perspective of research on medical expertise: The study of clinical performance. Medical Education, 41, 1124-1130.

Hall, R.L. (1979). Wittgenstein and Polanyi: The problem of privileged self-knowledge. Philosophy Today, 23, 267-278.

Hoge, M.A., Huey, L.Y., O’Connell, M.J. (2004). Best practices in behavioral health workforce education and training. Administration and Policy in Mental Health, 32, 91-106.

Holmboe, E.S., Sherbing, J., Long, D.M., Swing, S.R. & Frank, J.R. (2010). The role of assessment in competency-based medical education. Medical Teacher, 32, 676-681. 

Morgan, G. (2006). Images of Organization. Thousand Oaks, CA: Sage Publications, Inc

O’Connor, J. & McDermott, I. (1997). The art of systems thinking. San Francisco, CA: Thorsons.