The Value of Competency Profiles
The competency approach in health care is the preferred method to meet the mandate for public protection. A competency profile defines a profession’s scope of practice and it is used to afford access to the profession and address concerns about practice.
Concerns About Practice
When a complaint is lodged and investigated, the contextual details are gathered so that the performance can be evaluated by a committee of peers. They evaluate whether the contextual performance meets the minimum standards of competence. The process, which is very similar to the legal process, can involve significant time, expertise, and costs but the number of complaints that result in a formal disciplinary hearing are typically very few within the health professions (thankfully). You can view these hearings on the profession’s regulatory college website.
Access to the Profession
The competency profile also serves another purpose. It is used to inform entry-to-practice certification exams, educational program accreditation, and continuing competency maintenance. It is a process to ensure individuals meet and maintain the standards of practice of the profession.
In this use, it depends on individual practitioner assessment in the clinical context – either the assessment of a student by a registered/certified practitioner or the annual self-assessment one’s own practice. Competency committees can be struck to review these individual assessments but it is unclear how effective they can be if they are reviewing hundreds of individuals annually.
Ensuring Competent Practice
As mentioned above, these profiles almost always outline the full scope of practice versus identifying entry-to-practice competencies. Attempts have and are being made to distinguish the novice from the expert (see Patricia Benner’s work, the Royal College of Physicians and Surgeons of Canada’s Entrustable Professional Activities and CanMEDS Milestones, and the College of Traditional Chinese Medicine Practitioners + Acupuncturists of BC’s Career Span Competence). However, this work has yet to depart meaningfully from the problematic concepts that competency progression is directly related to time in practice (it’s not) and that competence is a trait (it’s a state).
Competency profiles serve the discipline process well and it is an adequate tool for designing curriculum and practice assessments. Without a comprehensive understanding of the contextual factors, I argue that is insufficient for ensuring competent practice. If you want to learn more about why competence needs to also be examined as a situated practice, contact me.