New ways of seeing: the role of systems thinking when developing competency frameworks in health professions education

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 Note that this is not peer-reviewed, and the pre-print has not been deposited elsewhere.



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, a lack of organizing frameworks, and difficulties in representing complex professional practice result in uncertainty regarding the validity and utility of competency frameworks. This necessitates additional ways of “seeing” practice when developing competency frameworks. We highlight what a systems-thinking conceptual framework 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 value when developing competency frameworks. We framed a systems thinking approach first by adapting Ecological Systems Theory (EST). EST offers a realist perspective of the person and environment, and the evolving interaction between the two. Second, we utilized complexity thinking, which obligates attention to the relationships and influences, to explore the multiple complex, unique, and context-embedded problems that exist within the messy, real-world system.


The ability to represent clinical practice when developing competency frameworks may be improved when features that may be relevant, including their potential interactions, can be identified and understood. A systems thinking approach makes visible features of a practice in context that may otherwise be overlooked in the development of competency frameworks.

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