Defining the boundaries of professional competence: Managing subtle cases of clinical incompetence.

Abstract

Flagrant cases of professional incompetence are often identified and corrected through formal remediation procedures. However, many subtle cases exist that can go undetected and uncorrected. This article describes a 5-component schema for categorizing the elements of competence necessary to provide quality psychological services: factual knowledge, generic clinical skills, orientation-specific technical skills, clinical judgment, and interpersonal attributes. Case examples are used to illustrate the types of problems that are likely to occur in these different areas. Peer education and supportive confrontation are suggested as appropriate means of addressing subtle cases of incompetence. Also, suggestions are made for system changes (graduate training, licensure requirements, and continuing education) designed to promote competence among clinicians.