Abstract
BackgroundMedical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development.MethodsGroup Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model’s development. They responded to the prompt ‘An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...’ and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation.ResultsSixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out.ConclusionThe domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.
Highlights
Medical education should ensure graduates are equipped for practice in modern health-care systems
On one hand Flexner has been lauded for the enormous contribution in bringing medical education into the twentieth Century progressive education movement [2], and on the other hand, arguments are made that the Flexner Report led to an individualistic, expert-centric culture which may work against the collaboration needed in modern health-care [3]
Through participatory concept mapping, we have developed a conceptual model of attributes and generic competencies that are required for doctors to contribute effectively in modern health-care systems
Summary
Medical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. The education of medical doctors has an important role to play in ensuring graduates are equipped for practice in modern health-care systems. On one hand Flexner has been lauded for the enormous contribution in bringing medical education into the twentieth Century progressive education movement [2], and on the other hand, arguments are made that the Flexner Report led to an individualistic, expert-centric culture which may work against the collaboration needed in modern health-care [3]. Burgeoning knowledge and evidence-base about medical conditions and their management, coupled with a dramatic increase in preventable, non-communicable chronic illness and multi-morbidity, changes in community expectations of health-care, and increasing ethical and professional challenges have created a circumstance whereby the contemporary requirements of doctors continues to be reevaluated [9]
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