05/05/2021 – this paper has now been accepted for publication in Advances in Health Sciences Education. The accepted version can be viewed here:

The revised second paper in my PhD is finally ready for peer-review. The abstract is contained below, and if you’re interested in reading the pre-print version, the link to the PDF is contained below the abstract. Note that this is not peer-reviewed, and the pre-print has not been deposited elsewhere.

17/11/2020 Update: further revised version is now available.


Competency frameworks provide a link between professional practice, education, training, and assessment. They support and inform downstream processes such as curriculum design, assessment, accreditation and professional accountability. However, existing guidelines are limited in accounting for the complexities of professional practice potentially undermining utility of such guidelines and validity of outcomes. This necessitates additional ways of “seeing” situated and context-specific practice. We highlight what a conceptual framework informed by systems thinking can offer when developing competency frameworks.

A Systems-Thinking Approach

Mirroring shifts towards systems thinking in program evaluation and quality improvement, we suggest that similar approaches that identify and make use of the role and influence of system features and contexts can provide ways of augmenting existing guidelines when developing competency frameworks. We framed a systems thinking approach in two ways. First by adapting Ecological Systems Theory (EST) which offers a realist perspective of the person and environment, and the evolving interaction between the two. Second, by leveraging complexity thinking, which obligates attention to the relationships and influences of features within the system, we can explore the multiple complex, unique, and context-embedded problems that exist within and have stake in real-world practice settings. 


The ability to represent clinical practice when developing competency frameworks can be improved when features that may be relevant, including their potential interactions, are identified and understood. A conceptual framework informed by systems thinking makes visible features of a practice in context that may otherwise be overlooked when developing competency frameworks using existing guidelines.