Developing competency frameworks in health professions

Last updated: 12/12/2022

A good place to start is this scoping review, which provides an overview of how competency frameworks have been developed in the health professions since the 1970s:

• Batt, A.M., Tavares, W., Williams, B. The development of competency frameworks in healthcare professions: a scoping review. Advances in Health Sciences Education. 2020;25(4):913-987. 10.1007/s10459-019-09946-w. Publisher link.

Next, two systematic reviews from Breanna Lepre and Nicole Murray, which explore the role of stakeholders in developing competency frameworks, and specifically patients and the public:

• Lepre B, Palermo C, Mansfield KJ and Beck EJ (2021) Stakeholder Engagement in Competency Framework Development in Health Professions: A Systematic Review. Frontiers in Medicine: Healthcare Professions Education. 8:759848. doi: 10.3389/fmed.2021.759848 Publisher link
• Murray, N., Palermo, C. Batt, A.M., Bell, K. Does patient and public involvement influence development of competency frameworks in the health professions? A systematic review. Frontiers in Medicine: Healthcare Professions Education. 2022, Jul.10.3389/fmed.2022.918915. [Q1]. Publisher link.

Next up, a conceptual framework which utilises systems thinking to structure exploration and understanding of practice, which we suggest is complex and contextual:

• Batt, A.M., Williams, B., Brydges, M., Leyenaar, M., Tavares, W. New ways of seeing: supplementing existing competency framework development guidelines with systems thinking. Advances in Health Sciences Education. 2021;26(4):1355-1371. 10.1007/s10459-021-10054-x. Publisher link.

Now armed with these historical perspectives and awareness of gaps in current approaches, comes the practical “how to make a competency framework” publication. This paper provides a synthesis of existing development guidance, combined with the conceptual framework outlined above, and a furthering of knowledge informed by mixed-methods research approaches, approaches to qualitative “rigour”, and other developments:

• Batt, A.M., Williams, B., Rich, J., Tavares, W. A six-step model for developing competency frameworks in the healthcare professions. Frontiers in Medicine: Healthcare Professions Education. 2021, Dec. 10.3389/fmed.2021.789828. Publisher link

If you wish to read the existing guidance on developing frameworks, there is a summary table provided in the first scoping review (Table 1, p915-917).

Specific guidance on methods that may be used during the development process is often generic based on method; however, specific insights from the competency framework development process are beginning to emerge:

• Allen L, Palermo C. Using Document Analysis to Develop Competency Frameworks: Perspectives from the revision of Competency Standards for Dietitians. Frontiers in Medicine: Healthcare Professions Education. Publisher link.
• Ash, Susan, Kerryn Dowding, and Susan Phillips. ‘Mixed Methods Research Approach to the Development and Review of Competency Standards for Dietitians’. Nutrition & Dietetics 68, no. 4 (2011): 305–15. https://doi.org/10.1111/j.1747-0080.2011.01552.x.
• Palermo, Claire, Jane Conway, Eleanor J. Beck, Janeane Dart, Sandra Capra, and Susan Ash. ‘Methodology for Developing Competency Standards for Dietitians in Australia’. Nursing & Health Sciences 18, no. 1 (March 2016): 130–37. https://doi.org/10.1111/nhs.12247.
• Arakawa, Naoko, and Lina R. Bader. ‘Consensus Development Methods: Considerations for National and Global Frameworks and Policy Development’. Research in Social and Administrative Pharmacy, 30 June 2021. https://doi.org/10.1016/j.sapharm.2021.06.024.
• Scodras, Stephanie, Kyla Alsbury-Nealy, Heather Colquhoun, Euson Yeung, Susan B. Jaglal, and Nancy M. Salbach. ‘Methodological Approaches for Identifying Competencies for the Physiotherapy Profession: A Scoping Review’. Discover Education 1, no. 1 (28 June 2022): 9. https://doi.org/10.1007/s44217-022-00008-9.

Generic methodological guidance that may be useful includes:

• Delphi: Trevelyan, Esmé G, and Nicola Robinson. ‘Delphi Methodology in Health Research: How to Do It?’ European Journal of Integrative Medicine, Diagnostic Techniques and Outcome Measures for Integrated Health, 7, no. 4 (1 August 2015): 423–28. https://doi.org/10.1016/j.eujim.2015.07.002.
• Mixed methods data integration: O’Cathain, Alicia, Elizabeth Murphy, and Jon Nicholl. ‘Three Techniques for Integrating Data in Mixed Methods Studies’. BMJ (Online) 341, no. 7783 (2010): 1147–50. https://doi.org/10.1136/bmj.c4587.
• Mixed methods: Creswell, John W, A Klassen, V Plano Clark, and Katherine Smith. ‘Best Practices for Mixed Methods Research in the Health Sciences’, 2014. https://doi.org/10.1002/cdq.12009.
• Reviews: Grant, Maria J, and Andrew Booth. ‘A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.’ Health Information and Libraries Journal 26, no. 2 (2009): 91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x.
• Rapid/restrictred reviews: Tricco, Andrea C., Hanan Khalil, Cheryl Holly, Garumma Feyissa, Christina Godfrey, Catrin Evans, Diane Sawchuck, et al. ‘Rapid Reviews and the Methodological Rigor of Evidence Synthesis: A JBI Position Statement’. JBI Evidence Synthesis, 4 March 2022. https://doi.org/10.11124/JBIES-21-00371.
• Curriculum mapping: Watson, Eilean Genevieve S., Carole Steketee, Kylie Mansfield, Maxine Moore, Bronwen Dalziel, Arvin Damodaran, Ben Walker, Robbert J. Duvivier, and Wendy Hu. ‘Curriculum Mapping for Health Professions Education: A Typology’. Focus on Health Professional Education: A Multi-Professional Journal 21, no. 1 (30 April 2020): 91. https://doi.org/10.11157/fohpe.v21i1.364.

Reporting of the development process has historically been lacking in detail required to make decisions around utility and validity. The CONFERD-HP Reporting Guideline provides an outline of the essential items that should be reported when discussing the development of a competency framework in the health professions:

• Batt, A.M., Tavares, W., Horsley, T., Rich, J., Williams, B., and the CONFERD-HP collaborators. CONFERD-HP: recommendations for reporting COmpeteNcy FramEwoRk Development in health professions, British Journal of Surgery, 2022;, znac394, https://doi.org/10.1093/bjs/znac394