Preparing Health Profession Students for Practice in Complex Real World Settings: How Do Educators Respond to a Model of Capability?

  • Dr Sally Hanks University of Plymouth Peninsula Dental School
  • Professor Hilary Neve Plymouth University Peninsula Schools of Medicine and Dentistry
  • Professor Thomas Gale University of Plymouth Peninsula Medical School
Keywords: capability, competency-based education, complexity, prepared for practice

Abstract

Undergraduate education often leaves future healthcare professionals insufficiently prepared for the complex and unpredictable workplace. Competency-based medical education (CBME) is widely utilised in health professions’ education, but a growing literature highlights its limitations. Capability is a complex concept which builds on competence, while embedding the integration and adaptation of knowledge, skills and personal qualities. While capability can prepare learners for uncertainty and complexity, the concept has been slow to progress within health professions’ education. We introduced the concept of capability to over 110 international health profession educators through six conference workshops, using a visual model to facilitate understanding. Participants’ post-workshop qualitative feedback was collated and thematically analysed. One hundred and thirty-three free text comments were received and four main themes identified: conceptualising capability, capability as curriculum goal, educating for capability, challenges to implementation. The need for capability resonated with participants, although most were unfamiliar with the concept prior to the workshop. The workshop enabled participants to recognise the limitations of CBME’s ‘tick box’ culture when preparing learners to address complexity. The model helped educators grasp the concept of capability and its potential value in health professions’ education. Participants were then able to identify challenges and suggest approaches for implementing capability in practice. Educating for capability is fundamental for preparing students successfully for the ‘real world’ of professional practice. Most participants agreed it should be the end goal of healthcare education curricula. Healthcare educators are likely, however, to need support to embrace this paradigm shift.

Author Biographies

Dr Sally Hanks, University of Plymouth Peninsula Dental School

Sally is Associate Head of School for Teaching and Learning at the Peninsula Dental School and a practising General Dental Practitioner

Professor Hilary Neve, Plymouth University Peninsula Schools of Medicine and Dentistry

Hilary is Associate Head of School for Teaching and Learning at the Peninsula Medical School and a practising General Practitioner 

Professor Thomas Gale, University of Plymouth Peninsula Medical School

Director of Assessment at the Peninsula Medical School and a consultant anaesthetist

References

Baillie, C., Bowden, J. A., & Meyer, J. H. F. (2013). Threshold capabilities: Threshold concepts and knowledge capability linked through variation theory. Higher Education, 65, 227–246. https://doi.org/10.1007/s10734-012-9540-5

Bates, J., Schrewe, B., Ellaway, R. H., Teunissen, P. W., & Watling, C. (2019). Embracing standardisation and contextualisation in medical education. Medical Education, 53(1), 15–24. https://doi.org/10.1111/medu.13740

Bishop, S. (2006). Using analogy in science teaching as a bridge to students’ understanding of complex issues. In J. H.F. Meyer, & R. Land (Eds.), Overcoming barriers to student understanding: Threshold concepts and troublesome knowledge. (pp. 182–194.). Routledge.

Bleakley, A., & Cleland, J. (2015). Sticking with messy realities: How ‘thinking with complexity’ can inform healthcare education research. In J. Cleland, & S. J. Durning (Eds.), Researching medical education (pp. 81-92). Wiley Online Books. https://doi.org/10.1002/9781118838983.ch8

Castillo, J-M., Park, Y. S., Harris, I., Cheung, J. J. H., Sood, L., Clark, M. D., Kulasegaram, K., Brydges, R., Norman, G., & Woods, N. (2018). A critical narrative review of transfer of basic science knowledge in health professions education. Medical Education, 52(6), 592-604. https://doi.org/10.1111/medu.13519

Caverzagie, K. J., Nousiainen, M. T., Ferguson, P. C., ten Cate, O., Ross, S., Harris, K. A., Busari, J., Bould, M. D., Bouchard, J., Iobst, W. F., Carraccio, C., Frank, J.R., & ICBME Collaborators. (2017). Overarching challenges to the implementation of competency-based medical education. Medical Teacher, 39(6), 588–593. https://doi.org/10.1080/0142159X.2017.1315075

Durning, S. J., Lubarsky, S., Torre, D., Dory, V., & Holmboe, E. (2015). Considering “nonlinearity” across the continuum in medical education assessment: Supporting theory, practice, and future research directions. Journal of Continuing Education in the Health Professions, 35(3), 232–243. https://doi.org/10.1002/chp.21298

Eva, K. W., Bordage, G., Campbell, C., Galbraith, R., Ginsburg, S., Holmboe, E., & Regehr, G. (2016). Towards a program of assessment for health professionals: from training into practice. Advances in Health Sciences Education, 21(4), 897–913. https://doi.org/10.1007/s10459-015-9653-6

Fraser, S. W., & Greenhalgh, T. (2001). Coping with complexity: educating for capability. British Medical Journal, 323(7316), 799–803. https://doi.org/10.1136/bmj.323.7316.799

Gardner, A., Hase, S., Gardner, G., Dunn, S. V., & Carryer, J. (2008). From competence to capability: a study of nurse practitioners in clinical practice. Journal of Clinical Nursing, 17(2), 250–258. https://doi.org/10.1136/bmjqs.2010.046714

General Medical Council. (2015). Developing a model for generic professional capabilities: A public consultation. London. https://www.ombudsman.org.uk/sites/default/files/Developing_a_framework_for_generic_professional_capabilities_form_English_writeable_final_distributed.pdf_61568131.pdf

General Medical Council. (2017). Developing a model for generic professional capabilities. https://www.gmc-uk.org/-/media/documents/generic-professional-capabilities-model--0817_pdf-70417127.pdf.

Ginsburg, S., McIlroy, J., Oulanova, O., Eva, K., & Regehr, G. (2010). Toward authentic clinical evaluation: pitfalls in the pursuit of competency. Academic Medicine, 85(5), 780–786. https://doi.org/10.1097/ACM.0b013e3181d73fb6

Glass, J. (2014). Competency-based training is a model for incompetence. British Medical Journal, 348, g2909. https://doi.org/10.1136/bmj.g2909

Govaerts, M., & Van der Vleuten, C. P. (2013). Validity in work‐based assessment: expanding our horizons. Medical Education, 47(12), 1164–1174. https://doi.org/10.1111/medu.12289

Hanks, S., Coelho, C., & Coster, R. (2018). Prepared for practice and equipped for employment: what do dental foundation trainers think of their trainees? British Dental Journal, 225(6), 549–555. https://doi.org/10.1038/sj.bdj.2018.756

Hawkins, R. E., Welcher, C. M., Holmboe, E. S., Kirk, L. M., Norcini, J. J., Simons, K. B., & Skochelak, S. E. (2015). Implementation of competency‐based medical education: are we addressing the concerns and challenges? Medical Education, 49(11), 1086–1102. https://doi.org/10.1111/medu.12831

Hay, D., Kinchin, I., & Lygo‐Baker, S. (2008). Making learning visible: the role of concept mapping in higher education. Studies in Higher Education, 33(3), 295–311. https://doi.org/10.1080/03075070802049251

Iedema, R. (2011). Creating safety by strengthening clinicians' capacity for reflexivity. BMJ Quality & Safety, 20(Suppl 1), i83–i86. https://doi.org/10.1136/bmjqs.2010.046714

Jabareen, Y. (2009). Building a conceptual framework: philosophy, definitions, and procedure. International Journal of Qualitative Methods, 8(4), 49–62. https://doi.org/10.1177/160940690900800406

Kalet, A., Chou, C. L., & Ellaway, R. H. (2017). To fail is human: remediating remediation in medical education. Perspectives on Medical Education, 6(6), 418–424. https://doi.org/10.1007/s40037-017-0385-6

Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: a systematic review. Advances in Health Sciences Education, 14(4), 595–621. https://doi.org/10.1007/s10459-007-9090-2

Meyer, J. H., & Land, R. (2005). Threshold concepts and troublesome knowledge (2): Epistemological considerations and a conceptual framework for teaching and learning. Higher Education: The International Journal of Higher Education and Educational Planning, 49(3):373–388. https://doi.org/10.1007/s10734-004-6779-5

Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63–7. https://doi.org/10.1097/00001888-199009000-00045

Monrouxe, L., Bullock, A., Cole, J., Gormley, G., Kaufhold, K., Kelly, N., Mattick, K., Rees, C., & Scheffler, G. (2014). How prepared are UK medical graduates for practice? Final report from a programme of research commissioned by the General Medical Council, UK. GMC.

Monrouxe, L. V., & Rees, C. E. (2017). Healthcare professionalism: improving practice through reflections on workplace dilemmas. John Wiley & Sons. https://doi.org/10.1002/9781119044475

Neve, H., Gilbert, K., & Lloyd, H. (2018). PBL as learning vehicle, threshold concept or capability?: audio-diary research in medical education. In M. Savin-Baden, & G. Tombs. Threshold concepts in problem-based learning (pp. 49–64). Brill Sense. https://doi.org/10.1163/9789004375123_005

Neve, H., & Hanks, S. (2016). When I say......... capability. Medical Education, 50(6), 610–611. https://doi.org/10.1111/medu.12956

O'Connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. Journal of Advanced Nursing, 70(12), 2728–2735. https://doi.org/10.1111/jan.12475

Perkins, D. (2006). Constructivism and troublesome knowledge. In: J. Meyer J & R. Land, R (Eds.), Overcoming barriers to student understanding: Threshold concepts and troublesome knowledge (pp. 33–47). Routledge.

Pusic, M. V., Santen, S. A., Dekhtyar, M., Poncelet, A. N., Roberts, N. K., Wilson-Delfosse, A. L., & Cutrer, W. B. (2018). Learning to balance efficiency and innovation for optimal adaptive expertise. Medical Teacher, 40(8), 820–827. https://doi.org/10.1080/0142159X.2018.1485887

Rees, C., & Richards, L. (2004). Outcomes-based education versus coping with complexity: should we be educating for capability? Medical Education, 38(11), 1203–1203. https://doi.org/10.1111/j.1365-2929.2004.02039.x

Rethans, J-J., Norcini, J. J., Barón‐Maldonado, M., Blackmore, D., Jolly, B. C., LaDuca, T., Lew, S., Page, G. G., & Southgate, L. H. (2002). The relationship between competence and performance: implications for assessing practice performance. Medical Education, 36(10), 901–909. https://doi.org/10.1046/j.1365-2923.2002.01316.x

Saldaña, J. (2013). The coding manual for qualitative researchers. SAGE.

Sandars, J., & Sarojini Hart, C. (2015). The capability approach for medical education: AMEE Guide No. 97. Medical Teacher, 37(6), 510–520. https://doi.org/10.3109/0142159X.2015.1013927

Schuwirth, L., & Van der Vleuten, C. (2011). Programmatic assessment: From assessment of learning to assessment for learning. Medical Teacher, 33(6): 478–485. https://doi.org/10.3109/0142159X.2011.565828

Stephenson, J. (1998). The concept of capability and its importance in higher education. In J. Stephenson, & M. Yorke (Eds.), Capability and quality in higher education (pp. 1–13): Kogan Page.

Swaffield, S. (2011). Getting to the heart of authentic assessment for learning. Assessment in Education: Principles, Policy & Practice, 18(4), 433–449. https://doi.org/10.1080/0969594X.2011.582838

ten Cate, O., Graafmans, L., Posthumus, I., Welink, L., & van Dijk, M. (2018). The EPA-based Utrecht undergraduate clinical curriculum: Development and implementation. Medical Teacher, 40(5), 506–513. https://doi.org/10.1080/0142159X.2018.1435856

ten Cate, O., & Scheele, F. (2007). Competency-based postgraduate training: can we bridge the gap between theory and clinical practice? Academic Medicine, 82(6), 542–547. https://doi.org/10.1097/ACM.0b013e31805559c7

Teunissen, P. W., Watling, C., Schrewe, B., Asgarova, S., Ellaway, R., Myers, K., Topps, M., Bates, J. (2021). Contextual Competence: how residents develop competent performance in new settings. Medical Education, Early View Feb 25. https://doi.org/10.1111/medu.14517

Wass, V., Van der Vleuten, C., Shatzer, J., & Jones, R. (2001). Assessment of clinical competence. The Lancet, 357(9260), 945–949. https://doi.org/10.1016/S0140-6736(00)04221-5

Wheelahan, L. (2007). What kind of curriculum, pedagogy & qualifications do we need for an uncertain future? In M. Osborne, M. Houston, N. Toman (Eds.), The pedagogy of lifelong learning: understanding effective teaching and learning in diverse contexts (pp 143–153). Routledge.

Whitehead, B., & Holmes, D. (2011). Are newly qualified nurses prepared for practice? Nursing Times, 107(19-20), 20–23.

Published
2021-05-26
How to Cite
Hanks, S., Neve, H., & Gale, T. (2021). Preparing Health Profession Students for Practice in Complex Real World Settings: How Do Educators Respond to a Model of Capability?. International Journal of Practice-Based Learning in Health and Social Care, 9(1), 50-63. https://doi.org/10.18552/ijpblhsc.v9i1.749
Section
Research Articles