Gersten Jonker

General introduction   15 1 THE DEVELOPMENT OF COMPETENCE A central construct in this thesis is competence. Competence is defined as the possession of the integrated range of interpersonal and technical competencies and abilities, across multiple aspects of performance, synthesized from relevant knowledge, skills, and attitudes, that are needed and habitually and judiciously used to perform tasks within the scope of professional practice [34, 39, 52]. An individual’s competence may develop further with continuing practice and learning or recede with disuse. Competence is to a certain extent context-dependent and may vary between situations, settings or environments, depending on factors and resources outside the individual [34, 48]. It includes expertise, professional judgments, and discernment of limits [39]. Societal, professional, and educational opinions on what the constituents of competence and being competent are is subject to change over time and culturally dependent [35]. As such, it does not only describe what is expected of a trained doctor, but also serves as a barrier to entry, progression, graduation, licensure, and certification [35]. Models, theoretical frameworks, and theories To understand how competence develops, we have to consult educational models, theoretical frameworks, and theories. One way to describe the development of competence is the model of Dreyfus & Dreyfus [53, 54]. It recognizes five stages from novice to expert and competence is not an end- point but themiddle stage of the spectrum. Reaching the competence state signifies the permission for unsupervised practice [48]. The expert state implies adaptive expertise, meaning that the professional can adapt her performance to the demands of a situation [54]. Ericsson emphasizes the importance of deliberate practice in his theoretical framework for the development of expertise [55]. It stresses the significance of continuing practice of a complex skill or activity over time. Moreover, engaging in the activity should be deliberate, i.e. the practitioner should counteract automaticity and stay aware of possibilities to keep improving performance at challenging levels. Building expertise on experience with the activity requires the practitioner to actively monitor and evaluate her execution of that activity.