Epidemiology of competence: a scoping review to understand the risks and supports to competence of four health professions

Abstract

ObjectivesThis study examined the risks and supports to competence discussed in the literature related to occupational therapists, pharmacists, physical therapists and physicians, using epidemiology as a conceptual model.DesignArticles from a scoping literature review, published from 1975 to 2014 inclusive, were included if they were about a risk or support to the professional or clinical competence of one of four health professions. Descriptive and regression analyses identified potential associations between risks and supports to competence and the location of study, type of health profession, competence life-cycle and the domain(s) of competence (organised around the CanMEDS framework).ResultsA total of 3572 abstracts were reviewed and 943 articles analysed. Most focused on physicians (n=810, 86.0%) and ‘practice’ (n=642, 68.0%). Fewer articles discussed risks to competence (n=418, 44.3%) than supports (n=750, 79.5%). The top four risks, each discussed in over 15% of articles, were: transitions in practice, being an international graduate, lack of clinical exposure/experience (ie, insufficient volume of procedures or patients) and age. The top two supports (over 35%) were continuing education participation and educational information/programme features. About 60% of all the articles discussed medical expert and about 25% applied to all roles. Articles focusing on residents had a greater probability of reporting on risks.ConclusionsArticles about physicians were dominant. The majority of articles were written in the last decade and more discussed supports than risks to competence. An epidemiology-based conceptual model offers a helpful organising framework for exploring and explaining the competence of health professions.

Teaching Future Dietitians Leadership: A General Needs Assessment

“…Within the context of health care, competence is integral to the delivery of safe, quality health care and other services that regulated health professionals provide (Academy of Nutrition and Dietetics [AND], 2013). Professional competence can evolve over time as health professions integrate new developments into clinical practice, expanding the body of knowledge and skills for each profession (Dower, Moore, & Langerlier, 2013;Takahashi, Nayer, & St. Armant, 2017). Competence to perform designated activities within defined practice settings is an essential element of health professionals' scopes of practice Bourgeault & Merritt, 2015).…”

“…In order to effectively develop, maintain, and support the competence of health professionals, education planners must account for the many elements of competence. These elements include context and continuum of practice to recognize that practitioners begin with entry-level competence and gain further competence in other or advanced areas of practice throughout their careers (Takahashi et al, 2017). In HPE, one major step is identifying where to best integrate components of instruction and assessment related to specific competencies, and plan curriculum around the question "What abilities are needed of graduates?"…”

“…CBE has emerged as a foundational framework for defining the outcomes, methods, and organization of HPE, with the core tenets of the CBE paradigm requiring an understanding of competence as multi-dimensional, dynamic, contextual, and developmental (Fitzgerald et al, 2016). CBE focuses on learning outcomes rather than teaching process, on abilities in addition to knowledge, on skill-based versus time-based training, and the promotion of learner-centeredness (Fitzgerald et al, 2016;Takahashi et al, 2017). The competency-based approach is used to specify health problems and tailor the curriculum to address gaps between what healthcare professionals learn, know, and do versus expectations of patients, stakeholders, and regulatory agencies (Barton, Bruce, & Schreiber, 2018;Frank et al, 2010).…”

“…The competency-based approach is used to specify health problems and tailor the curriculum to address gaps between what healthcare professionals learn, know, and do versus expectations of patients, stakeholders, and regulatory agencies (Barton, Bruce, & Schreiber, 2018;Frank et al, 2010). One of the unique components of the competency-based approach is that success is based on the learner's ability to successfully incorporate knowledge, skills, and attitudes in the context of practice in specific domains, which emphasizes higher-level cognitive skills (Takahashi et al, 2017). While the concept of CBE is not altogether new, a better understanding of the facilitators and barriers to acquiring competence is warranted (Takahashi et al, 2017).…”

“…One of the unique components of the competency-based approach is that success is based on the learner's ability to successfully incorporate knowledge, skills, and attitudes in the context of practice in specific domains, which emphasizes higher-level cognitive skills (Takahashi et al, 2017). While the concept of CBE is not altogether new, a better understanding of the facilitators and barriers to acquiring competence is warranted (Takahashi et al, 2017). In the next section, I will explore more deeply different definitions of leadership prevalent in health professions literature.…”