English - the European Oncology Nursing Society

electronic databases for literature retrieval, access virtual learningenvironments for links to additional learning material, and use mobiledevices, all contribute to the acquisition of transferable skills for caredelivery. Moreover, this enables students on graduation to functionmore effectively when faced with change like new informationsystems or technology in the workplace.Over the last twenty years the use of learning outcomes, as part ofan overall outcomes based approach used in education, has becomecommon in the USA, UK, Ireland, Australia, New Zealand and SouthAfrica. The Bologna process has created considerable interest andindeed movement towards adoption of a learning outcomes basedprocesses for programme design in Europe. This whole systemapproach makes integration of academic and vocational educationand training easier. It also aids the development and introductionof accreditation of prior learning, credit transfer and accumulationand lifelong learning frameworks. At an institutional level learningoutcomes can be expressed at programme and, or module level andcan be used to frame individual units of study such as a lecture ordirected learning activity. Learning outcomes also allow comparisonacross programmes and have the potential to act as an enabler fortransparent European harmonisation (Cowan et al 2005, Mallaberand Turner 2006). In parallel competency frameworks have beendeveloped to differentiate between different grades and expectationsof staff and better conceptualisation of current and future workforcerequirements. Examples of cancer nursing competency frameworksare available via the world wide web (eg. Weatherall 2004, TheNational Cancer Nursing Education Project [EdCAN] 2008) or forspecific competencies (see Consensus Panel on Genetic/GenomicNursing Competencies 2006; Skills for Health 2008)Competency and competenciesFor a profession such as nursing the main aim of any programmeof preparation for initial or specialist practice is that the learneracquires the necessary skills, knowledge and attitudes to practice;in effect that are competent. Establishing a definition of what ismeant by competency or indeed judging that an individual has metthe benchmark of competence is a challenge at best and one fraughtwith controversy (Watson et al 2002). Gonzci (1994) suggests thatthere are a number of ways of viewing of competency. One approachis to focus solely on the behaviour demonstrated by the individual, asecond is to consider the general characteristics demonstrated by anindividual that constitute effective performance; and the third is bydetermining the components that constitute the requirements for therole (competencies) that collectively will constitute competence. Allthese approaches have their weaknesses. The problem with merelyfocusing on behaviour is that underpinning knowledge is assumed,yet remains invisible, or by default viewed as unnecessary andpossibly undervalued. An attention on general attributes may resultin a practitioner failing to have acquired the specific requirementsof the role. Whereas reducing the art and science of nursing merelyto its component parts may not when reconstituted meet theexpectations of public (Calman 2006), employers, statutory andprofessional regulation (Mallaber and Turner 2006) or indeed theindividual. An even greater challenge is the complexity inherentin the measurement (assessment) of competence (Watson et al2002, Topping et al 2002). Despite these weaknesses competencyframeworks have been adopted in the health care sector as a meansof assessing capability, judging performance and even used as basisfor determining level of remuneration such as the scheme Agenda forChange and Knowledge and Skills Framework adopted in the UK (DH2004; DH 2007).Do learning outcomes and competencies reflect practice?The aim of systems that adopt learning outcomes and/orcompetencies is that they provide assurances about what agraduating student or employee will know and be able to do. In effectcreate confidence that practitioners that are produced are fit forpurpose and practice and meet the requirements of the academicaward. To achieve that aim learning outcomes and competenciesadopt the language of objectivity. This gives the impression thatjudging achievement through the use of such frameworks can bescientific in its precision (Hussy and Smith 2002). Whereas manyforms of assessment are anything but precise particularly whendemonstration of achievement of a learning outcome or competencyin the health sciences requires a complex interplay between thestudents knowledge, skills and attitudes, the assessors abilityto make the judgment, the test or task adequately extracts theevidence and the context is stable to ensure it does not influencethe assessment. In effect the reliability and validity, sensitivity andspecificity have to be assured. This is made even more complexin practice settings where control of the learning environment isdifficult particularly in terms of ensuring consistency. Practiceis essentially messy and indeterminate (Schon 1983). There isconsiderable and growing evidence that a range of factors influencepractice assessment not least the failure of assessors to failstudents (Duffy 2003) and the small tyrannies such as the personalcharacteristics of the learner that can influence outcomes. That saidthe levels of reported errors, adverse incidents and failure to reportsystematic failings in competency of health care practitioners inhealth care (European Commission 2005; Pietro et al 2000) createsa real impetus to establish robust approaches for the preparationand continued professional development of current and futuregenerations of practitioners. Hence the enthusiasm for frameworksEducation and training for health care professionals may preparethem for the role but it remains only an element of the necessarypreparation for expertise. It is now widely acknowledged thateducation alone will not result in expertise and that novicepractitioners require a period of consolidation to realise their skillsand knowledge. Exposure and emersion in practice, acts as a catalystfor the transformation and embedding of learning, and after a periodof time the development of expertise (Benner 1984, Benner et al1996, Topping et al 2002). A feature of practice emersion is thatthe learner gains familiarity with the unique features, and culturalnuances, of the particular specialism. However a particular concernnewsletter fall 2008 -5