Developing competency frameworks in health professions

Last updated: 27/07/2022

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 base don 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 (currently under peer-review) 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 healthcare professions. (preprint)

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