Competency-based education and assessment, the route to competent healthcare professionals.
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Clinical Competence↗
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Why residents should teach: a literature review.
Resident doctors contribute significantly to the quality of undergraduate medical training and it is assumed that by participating in the process, they also improve their own professional competency. We decided to investigate whether there is evidence to support this assumption. Our hypothesis, the physician-as-teacher rule, stated that "A skilled teacher has an increased likelihood of becoming a competent clinician, than a skilled clinician has of becoming a competent teacher". We conducted a literature review to search for evidence to confirm or refute this assumption. Twenty-four articles written after 1990 were identified as relevant from 132 references we generated by searching Medline. The identified articles were qualitatively reviewed to identify key research conclusions and/or main discussion points. The findings from the review were collated and discussed. None of the studies showed specific evidence of how teaching results in improved professional competence. However, there was evidence that teaching ability correlated positively with the perception of clinical competency. There was also need for improved supervision and training programmes for residents in teaching skills. The review provided evidence that teaching influenced the perceived professional competency of physicians positively. Physicians who were perceived as competent were those who taught effectively, and who had a basic understanding of teaching and learning. The review shows that training in teaching is essential for physicians, and that further research is still needed to demonstrate the effect of good teaching on professional competency.
Clinical Competence↗
A survey of pet owner views of veterinarians in Brisbane environs - a behavioral approach.
Three hundred and thirty-seven pet owners were interviewed by final-year veterinary students from the University of Queensland, using a questionnaire prepared by the authors. The survey area included Brisbane city and suburbs and was conducted in 1977. The majority of respondents (52.5%) reported that the pets were owned by the family, while 24.6% claimed that pets were owned by individual adults only. Dogs and cats were the most popular pets. Of the respondents sampled, 51% changed their veterinarian while 46% reported that they had not changed their veterinarian. Satisfaction with the service, nearness of the service and personal liking were the major reasons for continuing to use the same veterinary surgeon. Nearly 40% of respondents used the veterinary service on the basis of recommendation of friends, relatives and other people who owned similar types of pets. According to the respondents, major qualities for a good veterinarian are: competence and knowledge (86.9%), compassion for animals (61.7%), professional approach (which includes good listening and explanation, the instillation of confidence, integrity and appearance) (57.4%), regard for owners and their feelings (46.3%), good surgery conditions (14.2%) and reasonable fees (12.8%). While professional competence was reported as one of the important qualities of a good veterinary service, the majority (51%) of them disagreed with the statement that professional competence is the only thing that matters in the care of pets and many other social and interpersonal factors influenced their attitude towards the veterinary service. The application of behavioural sciences to the veterinary profession is discussed.
Animal Diseases↗
[Professional nursing competence must be recognized].
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Administrative Personnel↗
[Evaluation of professionals: competence-productivity. Who evaluates whom? Who evaluates what?].
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Employee Performance Appraisal↗
Competence equals professionalism.
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Altruism↗
Students' perceptions of effective and ineffective clinical instructors.
Clinical nursing faculty possess four categories of important qualities: professional competence, interpersonal relationship, personality characteristics, and teaching ability. The main purpose of this study was to understand of these four categories of qualities, which, taken together, was the main contributor to effectiveness differences among clinical nursing faculty. A total of 214 students from two nursing schools completed the questionnaire, using a 5-point Likert-type scale. The results showed that effective teachers possessed significantly high scores (> 4) in all of these four qualities. While the scores of ineffective teacher were lower (< 3) in all categories, except professional competence. Larger differences in scores between effective and ineffective teachers were found in the interpersonal relationship category, followed by the category of personality characteristics. Smaller differences in scores between effective and ineffective teachers were in the professional competence category, followed by the teaching ability category. From these results, we suggest that teachers' attitudes toward students, rather than their professional abilities, are the crucial difference between effective and ineffective teachers. This research also indicates that students from different nursing schools have similar opinions regarding this concern. Based on these findings, we highly recommend that teachers strive to improve their attitudes toward students as the best way to achieve the goals of clinical teaching.
Attitude of Health Personnel↗
Certification: a credential of professional commitment, competence, and expertise.
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Certification↗
Enhancing client competence: melding professional and client knowledge in public health nursing practice.
Providing health information is an important aspect of public health nursing. This article describes how public health nurses (PHNs) give information to enhance client competence. The findings are part of a larger study that explored PHNs perspectives and experiences of their practice. The study employed an exploratory descriptive qualitative research design. Data were gathered through in-depth individual and focus group interviews with 28 PHNs in Alberta, Canada. Content analysis revealed that nurses work to enhance client competence by sharing professional knowledge and by building on the client's experiential knowledge. Nurses provide information to assist clients with immediate concerns and for future use, PHNs use three main strategies to deal with immediate concerns: being direct, providing options, and presenting a different view. Information for future use focused on enhancing development and forestalling future problems. Nurses build on clients' experiential knowledge by acknowledging their present situation, giving positive feedback, being there, and gently persuading. The authors suggest that the melding of professional and client knowledge is foundational to health promotion approaches that enhance client competence. There is a need for further research that explores the intricacies of developing partnerships between professionals and clients that embrace a sharing of professional and experiential knowledge.
Alberta↗
Continuing competence and the regulation of nursing practice.
A study commissioned by the Australian Nursing Council Inc. sought to develop an approach to the maintenance of continuing competence in nursing that is broadly acceptable to nurses in all States and Territories. The study involved a comprehensive review of the international literature and this paper provides an overview of statutory regulation of professions with particular reference to regulation of the nursing profession. A definition of competence and competencies and a discussion of beginning and continuing professional competence are presented, followed by a review of current indicators of continuing professional competence used by a variety of professions in Australia.
Australia↗
Longterm effects of problem-based learning: a comparison of competencies acquired by graduates of a problem-based and a conventional medical school.
BACKGROUND: Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. PURPOSE: To study the longterm effects of problem-based medical training on the professional competencies of graduates. METHODS: A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. RESULTS: The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. CONCLUSION: The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice.
Adult↗
Self-reported competency ratings of graduates of a problem-based medical curriculum.
PURPOSE: To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. METHOD: All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own performances in 19 domains with those of colleagues trained at schools with conventional curricula. RESULTS: Overall, alumni of the medical school rated themselves as better than colleagues who were trained at schools with conventional curricula for cooperation skills, problem-solving skills, skills relevant to running meetings, and the ability to work independently. There was no difference for possession of general academic knowledge and writing reports or articles. The self-reported ratings of better competencies were maintained after correcting the data for self-overestimation. CONCLUSION: The problem-based medical curriculum appears to contribute to the development of professional competencies. Further study is needed, however, to control for the effect of selection bias and respondents' emotional commitment to their alma mater.
Attitude of Health Personnel↗
A survey on psychiatric patients' use of non-medical alternative practitioners: incidence, methods, estimation, and satisfaction.
OBJECTIVES: We investigated to what extent psychiatric inpatients consult Heilpraktiker, i.e. non-academically trained providers of complementary and alternative medicine (CAM), which diagnostic and therapeutic methods Heilpraktiker employ, how patients assess Heilpraictikers' professional competence, CAM in general and issues of satisfaction for those who have had experience with Heilpraktiker. DESIGN: Four hundred and seventy three patients admitted to a psychiatric university department during a 9-month period filled out a questionnaire developed for this investigation. RESULTS: About one third of the patients had consulted a Heilpraktiker, a quarter of these for their current psychiatric illness. Women were in the majority. Patients with the highest secondary school education consulted Heilpraktiker less often. There was considerable 'customer loyalty' towards Heilpraktiker. Largely the same diagnostic and treatment methods were employed for mental illness as for somatic complaints. Except for iridology, exotic or dangerous methods played a secondary role. Patients generally revealed a very positive attitude toward Heilpraktiker and CAM, although methods were rated differently. CAM enjoyed greater appreciation among women and patients who had consulted Heilpraktiker. Patients with personal experience were, on the whole, very satisfied with the professional competence, with the atmosphere in the practice and staff concern for the patient's well-being. Degree of satisfaction correlated closely with frequency of consultation. More patients with neurotic disorders considered the cost unreasonable than others, despite comparatively frequent visits. CONCLUSIONS: Psychiatric patients seek out Heilpraktiker to a considerable degree. Especially those who have relevant experience rank Heilpraktiker highly, in particular due to their 'psychotherapeutic' attitude, but professional competence is also valued. Methods of CAM received mixed reviews from patients but are generally seen in a positive light. It is recommended that doctors collecting case history data on their patients also ask about experience with alternative practitioners and treatments.
Adult↗
Understanding the job in a new way--a basis for development of competence in diabetes care.
Patients complain that doctors and nurses do not listen, and therefore a need to develop the patient encounter is at hand. Phenomenological theory has opened new ways to develop professional competence. If the idea holds that we express our understanding about our work through our actions, a change in understanding might further develop professional competence. This idea offers a new way to develop competence in diabetes health care service. The aim of this study was to map health care professionals' understanding of the patient encounter before and after an educational intervention that focused the way the health care professional experienced the encounter, and to describe how their understanding changed. Two general practitioners and two diabetes nurses participated. They were interviewed before and after the intervention. The intervention comprised 4-5 sessions during which they together with a tutor reviewed their videotaped consultations with different persons with diabetes. The tutors' role was to make interventions that could alter the persons understanding of the diabetes consultation through questioning. The interviews were analysed using phenomenographic method. The results show that the professionals changed their ways of experiencing the encounter after the intervention. They started to question their way of working, focused the patient's learning process and became interested in how to stimulate it.
Diabetes Mellitus↗
Improving health service management education: the manager speaks.
This paper uses health service manager judgements to discuss educational approaches and environments suitable to the development of required competencies and reports barriers to and opportunities for competency development. Practising managers were found to recognise and value the educational contributions made by academic programs, health service organisations and professional associations to the development of professional competence. Academic programs are seen as the appropriate vehicle for developing conceptual, analytical, problem solving and communication competencies that require considerable maturation time. Health service organisations are seen to have a key role in promoting professional competence through maintaining a culture conductive to encouraging managers to undertake further education, supported by appropriate system strategies. Professional associations are regarded as appropriate sponsors for promoting knowledge and skill update in relation to current issues in management through short courses, conferences and timely educational meetings. Wherever possible, collaboration between professional and educational organisations was seen to be desirable.
Adult↗
[Effects of an intensive therapy program for behaviorally disordered mentally handicapped patients on staff personnel in residential care].
This study evaluates the effects of an intensive therapy program designed for mentally handicapped persons with severely disturbed or autistic behavior on their staff personal which had an active role in the program. The staff members rated their professional competence, quality of interaction with the client, team culture and work satisfaction before and after being engaged in the program, with additional ratings of their personal aims at the beginning of the program. Three sets of data were obtained with the program being conducted three times in a row. The testings of the related as well as the independent samples show differentiated program effects. The main effect is an increase of the professional competence and quality of interaction, especially by the qualified staff members. Trainees put emphasis on the development of their personal relationship with the client. The results are discussed in terms of the impact of learning processes specific to the roles of the staff members and motivational factors on learning and therapy outcome, along with institutional conditions influencing successful learning. Thus the program facilitates the professional and interpersonal learning process of staff members in a specific way with success as well as with limitations.
Autistic Disorder↗
Professionalism for medicine: opportunities and obligations.
Physicians' dual roles - as healer and professional - are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical - with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values.
Ethics, Medical↗
Professionalism for medicine: opportunities and obligations.
Physicians' dual roles--as healer and professional--are linked by codes of ethics governing behaviour and are empowered by science. Being part of a profession entails a societal contract. The profession is granted a monopoly over the use of a body of knowledge and the privilege of self-regulation and, in return, guarantees society professional competence, integrity and the provision of altruistic service. Societal attitudes to professionalism have changed from supportive to increasingly critical--with physicians being criticised for pursuing their own financial interests, and failing to self-regulate in a way that guarantees competence. Professional values are also threatened by many other factors. The most important are the changes in healthcare delivery in the developed world, with control shifting from the profession to the State and/or the corporate sector. For the ideal of professionalism to survive, physicians must understand it and its role in the social contract. They must meet the obligations necessary to sustain professionalism and ensure that healthcare systems support, rather than subvert, behaviour that is compatible with professionalism's values.
Altruism↗