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Professional: Defining Competency

Why Do We Need Professionals?

"Professional" Defined

The word professional is used by different people in different ways. It is used as an adjective to describe a certain kind of behaviour that is usually meant to be calm, controlled, objective and not interested in personal gain.

When used as a noun, it is meant to signify an individual who has, through a combination of education and experience, attained a certain trusted and respected status in society. Within a legal context, professionals are a carefully defined group of individuals to whom specific and important responsibilities and roles have been allocated.

Sociologists generally define a profession as a specialized field of practice requiring application of scientific knowledge. In general, they contrast professionals with technicians, each of whom contributes in important but distinct ways, to society.

While technicians will apply scientific rules (guidelines, algorithms) to solve everyday problems in a predictable way, professionals are generally seen as individuals who are well-versed in these rules but who must solve ill-defined problems in ambiguous situations where algorithms or guidelines may simply not apply.

While technicians assume great responsibility to get the right answer in circumstances where this is possible, professionals must assume the responsibility of determining the “least worst alternative” when no right answer is actually even possible.

Health Professionals

Within the health care environment, it is easy for many professionals—like physical therapists—to overlook this distinction. Increasingly many health professionals are employees, and consequently work within practice settings that are dominated by standard operating procedures, decisional hierarchy, and limited scope to apply judgement or discretion.

In some cases, such environments may be demotivating for some professionals, who feel like they are simply cogs in a machine rather than well-educated, motivated individuals with unique skills and knowledge to share.

Environmental Ambiguity

In his seminal book “The Reflective Practitioner” (1983), the philosopher Donald Schon noted that professional work—and decision making—is characterized by “messiness”: environmental ambiguity that makes straightforward application of rules difficult. Professionals must routinely make decisions that are by their nature not very routine: if obvious answers existed, professionals wouldn’t be needed.

As the complexity of health care increases, the ambiguity and messiness of the environment expands. Today’s health care professional is commonly faced with multiple decisions requiring balancing of risks and benefits, costs, and pros and cons, and s/he must make decisions that are in some cases unpopular or difficult to implement.

Related link: Professionalism - Difficult to Teach and Hard to Evaluate 

Defining Competency

In an environment where there is “no right answer” but only “least worst alternatives”—how are we to assess the competency of a professional? The centrality of a professional’s work context to the actual practice of that profession makes defining competence very challenging.

Increasingly, regulators are recognizing and responding to this challenge with innovative ways of defining, measuring, and supporting competency in their professions. 

A key feature of such innovations includes the recognition that professional work is unique and inherently messy, and that competency assessment needs to be linked to the context and environment of the profession. While in the past, competency may have been viewed as a technical skill, increasingly it is seen by regulators as an ability to manage diminishing resources in challenging environments to secure best possible outcomes.

Professionals themselves need to remember their vital role in society and re-consider what it means to be competent today. Beyond scientific knowledge and technical skills, professional competency today requires dedication to patients, investment in one’s profession, engagement in the workforce, and attentiveness to what society expects—and needs—from us.