Epidemiology of competence: A scoping review to understand the risks and supports to competence of four health professions

Abstract

Objectives This study examined the risks and supports to competence discussed in the literature related to occupational therapists, pharmacists, physical therapists and physicians, using epidemiology as a conceptual model. Design Articles from a scoping literature review, published from 1975 to 2014 inclusive, were included if they were about a risk or support to the professional or clinical competence of one of four health professions. Descriptive and regression analyses identified potential associations between risks and supports to competence and the location of study, type of health profession, competence life-cycle and the domain(s) of competence (organised around the CanMEDS framework). Results A total of 3572 abstracts were reviewed and 943 articles analysed. Most focused on physicians (n=810, 86.0%) and 'practice' (n=642, 68.0%). Fewer articles discussed risks to competence (n=418, 44.3%) than supports (n=750, 79.5%). The top four risks, each discussed in over 15% of articles, were: transitions in practice, being an international graduate, lack of clinical exposure/experience (ie, insufficient volume of procedures or patients) and age. The top two supports (over 35%) were continuing education participation and educational information/programme features. About 60% of all the articles discussed medical expert and about 25% applied to all roles. Articles focusing on residents had a greater probability of reporting on risks. Conclusions Articles about physicians were dominant. The majority of articles were written in the last decade and more discussed supports than risks to competence. An epidemiology-based conceptual model offers a helpful organising framework for exploring and explaining the competence of health professions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Keywords

Author Keywords

Competence supports Risks Epidemiology health professions

Index Keywords

adult clinical competence female human male Humans Risk assessment Vocational education physician occupation medical profession Health Occupations Regression analysis Physicians major clinical study mentor pharmacist resident Social support Mentors Education, Professional probability physiotherapist Physical Therapists Life cycle continuing education occupational therapist Occupational Therapists Pharmacists medical expert

Author Affiliations

Department of Postgraduate Medical Education, University of Toronto, Toronto, ON, Canada

Funding & Acknowledgements

Royal College of Physicians and Surgeons of Canada

The authors would like to acknowledge Dr Salvatore Spadafora, Vice Dean of Post MD Education, University of Toronto and Dr Glen Bandiera, Associate Dean of Post MD Education, University of Toronto for all of their support in conducting this research. Specific thanks to Shanil Ebrahim, assistant professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University for his role as the consulting epidemiologist; Sheena Bance, PhD candidate in Clinical Psychology at the University of Toronto, Ontario Institute for Studies in Education, for her assistance with project coordination and abstracting and to our colleague Melissa Hynes, PhD(c) for her assistance with project management and abstracting. We appreciate the funding that supported the final stages of completing this research through the unrestricted educational grant from the Physician Factors Steering Committee and their cochairs Dan Faulkner (College of Physicians and Surgeons of Ontario, CPSO) and Dr Karen Mazurek (College of Physicians and Surgeons of Alberta, CPSA). A special note of appreciation to Wendy Yen and Niels Thakkar of CPSO for their attention to the descriptions of study variables.

Canadian Political Science Association, CPSA

The authors would like to acknowledge Dr Salvatore Spadafora, Vice Dean of Post MD Education, University of Toronto and Dr Glen Bandiera, Associate Dean of Post MD Education, University of Toronto for all of their support in conducting this research. Specific thanks to Shanil Ebrahim, assistant professor in the Department of Clinical Epidemiology and Biostatistics at McMaster University for his role as the consulting epidemiologist; Sheena Bance, PhD candidate in Clinical Psychology at the University of Toronto, Ontario Institute for Studies in Education, for her assistance with project coordination and abstracting and to our colleague Melissa Hynes, PhD(c) for her assistance with project management and abstracting. We appreciate the funding that supported the final stages of completing this research through the unrestricted educational grant from the Physician Factors Steering Committee and their cochairs Dan Faulkner (College of Physicians and Surgeons of Ontario, CPSO) and Dr Karen Mazurek (College of Physicians and Surgeons of Alberta, CPSA). A special note of appreciation to Wendy Yen and Niels Thakkar of CPSO for their attention to the descriptions of study variables.

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Epidemiology of competence: A scoping review to understand the risks and supports to competence of four health professions

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