The Question of Competence

The Question of Competence: Reconsidering Medical Education in the Twenty-First Century

Brian D. Hodges
Lorelei Lingard
with a Foreword by M. Brownell Anderson
Copyright Date: 2012
Edition: 1
Published by: Cornell University Press,
Pages: 240
https://www.jstor.org/stable/10.7591/j.cttn34ns
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  • Book Info
    The Question of Competence
    Book Description:

    Medical competence is a hot topic surrounded by much controversy about how to define competency, how to teach it, and how to measure it. While some debate the pros and cons of competence-based medical education and others explain how to achieve various competencies, the authors of the seven chapters in The Question of Competence offer something very different. They critique the very notion of competence itself and attend to how it has shaped what we pay attention to-and what we ignore-in the education and assessment of medical trainees.

    Two leading figures in the field of medical education, Brian D. Hodges and Lorelei Lingard, draw together colleagues from the United States, Canada, and the Netherlands to explore competency from different perspectives, in order to spark thoughtful discussion and debate on the subject. The critical analyses included in the book's chapters cover the role of emotion, the implications of teamwork, interprofessional frameworks, the construction of expertise, new directions for assessment, models of self-regulation, and the concept of mindful practice. The authors juxtapose the idea of competence with other highly valued ideas in medical education such as emotion, cognition and teamwork, drawing new insights about their intersections and implications for one another.

    eISBN: 978-0-8014-6580-2
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Foreword
    (pp. ix-xii)
    M. Brownell Anderson

    Medical education has been the subject of repeated examinations and in-depth reports about changes that are needed to improve the education of physicians. In 1910, Abraham Flexner wrote a report, funded by the Carnegie Foundation for the Advancement of Teaching, that advocated for changes and promoted standards for medical schools and is credited with changing the way doctors are educated. Perhaps most important, Flexner made medical education a social cause, demonstrating its importance in everyone’s life. Flexner’s work exposed poor educational content and processes in the preparation of physicians and began what has been a century-long concern with the quality...

  4. Acknowledgments
    (pp. xiii-xiv)
  5. List of Abbreviations
    (pp. xv-xviii)
  6. Introduction
    (pp. 1-13)
    Brian D. Hodges and Lorelei Lingard

    In the past decade, competence has grown to the status of a “god term” in medicine and in many other health care disciplines (Burke 1935): an idea with such power that it readily trumps other, competing ideas to shape our educational values and decisions in innumerable—and often invisible—ways. It is, hands down, the governing notion underpinning our sense of what medical education should be striving for in the twenty-first century, overshadowing other popular notions including simulation, objective assessment, professionalism, and patient-centeredness.

    Almost ten years ago, the shift from a traditional content-based curriculum to a competency-based curriculum was called...

  7. 1 The Shifting Discourses of Competence
    (pp. 14-41)
    Brian D. Hodges

    Competence is a word that is so frequently used, in so many different ways, that it risks having no meaning at all. As mentioned in the introduction, Lingard (2009, 625) has called competence a “god term,” a word so weighty that its mere use trumps other considerations. To articulate the need for better tools for the assessment of competence is to invite a concerted nodding of heads. But what is competence? A common approach to this question is to concretize the term in a list of skills and attributes that presumably, taken together, define competence. A more recent and increasingly...

  8. 2 Rethinking Competence in the Context of Teamwork
    (pp. 42-69)
    Lorelei Lingard

    Rarely can a patient’s health care needs be met by a single care provider. Patients who go to their family doctor with persistent headaches interact with the physician and the nurse in the office, and may get referred to a specialist or sent to have a diagnostic imaging test. Patients with chronic conditions like diabetes will interact with a number of providers in addition to their family doctor, such as endocrinologists, ophthalmologists, and dietitians. Patients who go to an emergency department with chest pain will be seen by a nurse and an emergency physician, and may also be assessed by...

  9. 3 Perturbations: The Central Role of Emotional Competence in Medical Training
    (pp. 70-96)
    Nancy McNaughton and Vicki LeBlanc

    In this chapter we examine the role of emotion as an integral, and often underappreciated, component of competency in the health professions from different scientific perspectives and discuss the implications for health professional training and practice.

    Within the health professions, emotion sits uneasily at the intersection between objective scientific fact and subjective humanistic values as a site of productive contestation. It is widely acknowledged as a core element of professional values, attitudes, and beliefs, as well as of humanistic approaches to professional activities—counseling, patient management, and communication. It is also recognized as an essential aspect of professional well-being and...

  10. 4 Competence as Expertise: Exploring Constructions of Knowledge in Expert Practice
    (pp. 97-112)
    Maria Mylopoulos

    Excellence in the education and training of future experts is crucial to the success of all professions. Extensive efforts have therefore been made to explore expertise, with the aim of translating understanding of expert performance into more effective expert development. However, our understanding of what it means to perform at the highest levels of a profession and the particular competencies that we value as the core of excellence have proven to be dynamic, and often controversial, issues. Over the last half century, the accrual and organization of an extensive knowledge base have become widely accepted by educators and researchers as...

  11. 5 Assessing Competence: Extending the Approaches to Reliability
    (pp. 113-130)
    Lambert W. T. Schuwirth and Cees P. M. van der Vleuten

    The planning committee of the new Suntree Medical School was meeting to design a new assessment program for the curriculum. The members of the committee quickly agreed that the program should be fair, transparent, and defensible. They also agreed to make it as comprehensive as possible, covering not only “hard” factual knowledge but also skills, insights, attitudes, and professional abilities. On top of that, they realized the importance of including both modular and longitudinal elements of assessment.

    At this point the committee got stuck. How were they going to reconcile the notions of fairness, transparency, and defensibility with the multifaceted...

  12. 6 Blinded by “Insight”: Self-Assessment and Its Role in Performance Improvement
    (pp. 131-154)
    Kevin W. Eva, Glenn Regehr and Larry D. Gruppen

    In Carroll’s Through the Looking Glass Alice discovers a poem, “Jabberwocky,” that can be read only when held up to a mirror. So too have many others suggested that we as individuals can read ourselves only through deliberate acts of reflection. Among professionals ranging from athletic coaches to business leaders, there is a general belief that the path to better performance is through “looking in the mirror” to openly and honestly identify one’s weaknesses and take steps to improve them. As a result, many models of professional self-regulation worldwide and many health professional training curricula have incorporated some form of...

  13. 7 The Competent Mind: Beyond Cognition
    (pp. 155-176)
    Annie S. O. Leung, Ronald M. Epstein and Carol-Anne E. Moulton

    Judgment and decision making in the health care setting has mostly been conceptualized and researched as an individual activity—situated in the heads of physicians or health care professionals. Measurement of competence in medicine is therefore often a test of individual competence. Is this surgeon competent to perform the operations on her own? Can this nurse detect a patient who has become critically ill? Inarguably, there are essential competencies that need to be taught, learned, and assessed prior to stamping the seal of independence on any health care practitioner. This conceptualization of competence as an individual activity situated in the...

  14. References
    (pp. 177-204)
  15. Contributors
    (pp. 205-208)
  16. Index
    (pp. 209-220)