Tag Archives: trust

Competency: necessary but not sufficient

This site is primarily a forum for highlighting limitations and frustrations with technical aspects of the the NHS ePortfolio. However, inevitably the discussion often broadens to problems with the ethos of training, or how it is perceived, and specific problems with the tools currently used to assess trainees. I was pointed in the direction of this paper by Dr AnneMarie Cunningham via Twitter. It highlights some of the issues with respect to the limitations of competency-based assessment of complex professional abilities.

A few points that struck a chord were:

* Competence does not necessarily predict performance

The sum of what professionals do is far greater than any parts that can be described in competence terms

* How do we assess “trustworthiness?”  –>  otherwise known as “the granny test”? The question “would you trust this doctor to care for your unwell grandmother?” may be a better test of trainee progress than any competency test

* The idea of trust reflects a dimension of competence that reaches further than observed ability. It includes the real outcome of training—that is, the quality of care

*  Innovation of postgraduate training should focus on expert appraisal of performance in practice

I hope that those responsible for postgraduate training engage trainees and ensure any future changes are; appropriate, of benefit to trainees and trainers, are evidence-based and “real-world tested.” A common theme from trainees is that current training is tick-box, uninspiring and lacks true mentor/mentee relationships. Olle Ten Cate’s paper contributes to this debate by highlighting the concept of trust and the complexity of assessing professional activities.

Postgraduate training can be better. But it requires enthusiastic mentors who are given the time, support, and freedom to educate and inspire the next generation of doctors.