Criteria For Competence

One of developmental psychology's central concerns is the identification of specific "milestones" which indicate what children are typically capable of doing at different ages. Work of this kind has a substantial impact on the way parents, educators, and service-oriented professionals deal with children; and, therefore one might expect that developmentalists would have come to some general agreement in regard to the ways they assess children's abilities. However, as this volume demonstrates, the field appears to suffer from a serious lack of consensus in this area. Based on the premise that identifying relevant issues is a necessary step toward progress, this book addresses a number of vital topics, such as: How could research into fundamental areas (such as the age at which children first acquire a sense of self or learn to reason transitively) repeatedly yield wildly diverse results? Why do experts who hold to radically different views appear to be so unruffled by this same divergence of professional opinion? and, Are there grounds for hope that this divergence of professional opinion is on the wane?

Some conferences produce proceedings, others an inspiration to labor, which finally leads to a published work. Such has been the case with regard to this volume. In 1984, the Center for Ethics, Medicine, and Public Issues held a conference with the title 'When are Competent Patients Incompetent?' with the support of the Texas Committee for the Humanities, a state-based program of the National Endowment for the Humanities. Assistance was provided by both Baylor College of Medicine and the Institute of Religion. This conference evoked a con siderable interest in examining further the moral status of competency determinations in the clinical setting. This interest is realized in this volume, which now affords us an opportunity to thank all those individ uals who made the conference possible, only some of whom are acknowledged in this Preface. In particular, we wish to express our gratitude to Baruch A. Brody, Rebecca Dresser, the Honorable Jerome Jones, H. Steven Moffic, Margery W. Shaw, Eleanor Tinsley, and Albert Van HeIden. The volume took its shape through the labors of Earl Shelp and Mary Ann Gardell Cutter, who inspired the further evolution of the papers presented at the conference and attracted contributions from individuals who had not attended. Earl Shelp and Mary Ann Gardell Cutter have produced a volume following extensive reflection and dialogue; they were ably assisted in the final preparation of the manu script by Thomas J. Bole III and George Khushf, to whom special thanks are due.

The book explains how assessments should be conducted and offers detailed, practice-tested interview guidelines to assist medical practitioners in this task. Numerous case studies illustrate real-life applications of the concepts and methods discussed. Grisso and Appelbaum also explore the often difficult process of making judgments about competence and describe what to do when patients' capacities are limited.".

The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.

Some conferences produce proceedings, others an inspiration to labor, which finally leads to a published work. Such has been the case with regard to this volume. In 1984, the Center for Ethics, Medicine, and Public Issues held a conference with the title 'When are Competent Patients Incompetent?' with the support of the Texas Committee for the Humanities, a state-based program of the National Endowment for the Humanities. Assistance was provided by both Baylor College of Medicine and the Institute of Religion. This conference evoked a con siderable interest in examining further the moral status of competency determinations in the clinical setting. This interest is realized in this volume, which now affords us an opportunity to thank all those individ uals who made the conference possible, only some of whom are acknowledged in this Preface. In particular, we wish to express our gratitude to Baruch A. Brody, Rebecca Dresser, the Honorable Jerome Jones, H. Steven Moffic, Margery W. Shaw, Eleanor Tinsley, and Albert Van HeIden. The volume took its shape through the labors of Earl Shelp and Mary Ann Gardell Cutter, who inspired the further evolution of the papers presented at the conference and attracted contributions from individuals who had not attended. Earl Shelp and Mary Ann Gardell Cutter have produced a volume following extensive reflection and dialogue; they were ably assisted in the final preparation of the manu script by Thomas J. Bole III and George Khushf, to whom special thanks are due.

Competence-based assessment is the cornerstone of the UK Government's reforms of vocational training and of non-academic full-time education post-16. Australia has adopted similar policies, and there is considerable interest in the notion of 'competence' in both Europe and North America. Alison Wolf describes the main characteristics of the competence-based approach as it has emerged in the UK, and traces its origins in American experimental programmes of the 1970s. The arguments for the approach are discussed in detail. Many of these arguments derive from the demonstrable limitations of more conventional assessment, especially in predicting work performance. She then analyses the theoretical assumptions which competence-based assessment shares with the criterion-referenced movement as a whole, distinguishing clearly between those claims which can be sustained and those which cannot. She also synthesizes the growing body of evidence on implementation. Many lessons have now been learned about whether and how one can establish a workable, robust and reliable competence-based system. It has become evident both that the preconditions for success are often missing, and that, if they are ignored, competence-based 'reforms' may have largely negative consequences. The final chapter reviews the prospects for competence-based awards, and offers some conclusions on what is essential to a competence-based approach.