Professional Competence-Complexity, Concepts and Characteristics: a Case Study of New Zealand Pharmacy

Abstract

This thesis sets out to develop a model of professional competence that takes into account the complexity associated with pharmacy practice. The resulting model conceptualises competence in a way that recognises it is a multi-leveled entity that develops and changes over a practitioner's practicing life. The model enables the characteristics that differentiate between levels of performance to be identified and explored. The thesis responds to the issues raised by the emerging emphasis on audit and competence assurance resulting from the introduction of The Health Practitioners Competence Assurance Act 2003 in New Zealand. It investigates the concept of professional competence as exhibited by experienced practising pharmacists, how it is defined, and how it evolves through ongoing practice. The research identifies behaviours that differentiate expert, competent and not-competent performance. As a result of the research undertaken, a new model of professional competence for pharmacists is proposed. This model uses complexity theory to move beyond traditional conceptions of competence, which are based on performance of roles and functions and focus on separate tasks and knowledge. Instead, it proposes that professional competence is a complex, separate entity in its own right, which is reflected in the roles and functions pharmacists perform. In the model, the ability to perform professional tasks competently is termed the domain of technical competence, but is only one component of professional competence. The other components are contained in four other domains of competence - cognitive, legal/ethical, organisational, and inter/intra-personal. Each of these domains is expressed in a continuum of behaviours, which at one end reflects the characteristics of the domain totally unconnected with the other domains. At the other end of the continuum the behaviour exhibited reflects the full integration of all the domains. "Competent" pharmacists are able to integrate the five domains of competence when performing their professional roles. Conceptualising professional competence in this way enables the importance of complex integrated behaviours of professional practice to be recognised without trying to break them into component parts. An example is the ability to draw apparently unconnected pieces of information together when deciding on appropriate actions for particular situations. "Not-competent" performance is characterised by a lack of ability to fully integrate the five domains of competence. This is often exhibited in a lack of ability to integrate one of the domains, for example, not applying legal or ethical judgments to decisions made or not communicating clearly in English. "Expert" performers on the other hand are able to integrate the skills and knowledge within each of the domains across a wider range of practice situations more consistently than competent performers. In doing so, experts are less reliant on standard professional and process knowledge, and instead use personal knowledge and experience to underpin their practice. This is reflected in their ability to act in more intuitive and creative ways. The model also provides a means of differentiating between "specialist" and "expert" performers. While experts are able to integrate the domains of competence more consistently and across a wider range of practice situations than competent performers, specialists demonstrate a greater ability in just one or two of the domains. This is most commonly exhibited by a specialist having a body of in-depth clinical knowledge within the cognitive and technical domains, or a specialist manager having a high level of proficiency in the organisational domain. In merging the domains together, the competent professional will perform professional tasks and functions and in doing so will exhibit patterns of behaviour appropriate to their situational context. Judgments of competence can be made based on such behaviours. Competence assurance is, therefore, viewed as situational, and evaluation methods are required that take this into account. The thesis proposes that the methods used for competence assurance of health professionals should take a complex view of professional competence, and focus on the integrated behaviours that differentiate performance. It also proposes that the integrated, complex model of professional competence can have profound impacts on curriculum development for initial pharmacist education and continuing professional development activities.