Competency-Based Education & Training

Skilled health workers of all kinds, at all levels of care (hospital to community), are the most critical component of a well-functioning health system. Yet, such human resources for health are typically in very short supply in developing countries due to a wide range of factors, including lack of effective education and training. Effective education and training strategies, implemented by well-qualified instructors, are essential for producing and sustaining an adequate number of proficient health care providers. Successful learning strategies are based on evidence, follow instructional design principles and support life-long learning. A competency-based approach to pre-service education (producing nurses, midwives and doctors who are competent to provide quality care upon graduation) and in-service training (updating the knowledge and skills of service providers, supervisors and other health workers already in the field) is participatory, relevant and practical. Qualified educators and trainers are essential for facilitating the transfer of knowledge, as well as skills (e.g., clinical decision-making, communication, psychomotor) and appropriate attitudes, to health care providers so they can perform their jobs competently, to a high standard of quality and with care.

In order for learning solutions to be effective and sustainable in a given setting:

  • Specific interventions must be aligned with local health priorities and workforce development needs;
  • Individual schools and health facilities, as well as national regulatory bodies, require the capacity to assess and improve their education and training systems, on an ongoing basis, according to educational and clinical service delivery standards; and
  • Appropriate learning approaches should be made available throughout health workers’ careers—often in a blended manner (e.g., traditional classroom-based instruction can be augmented by using computer-based technologies to create narrated presentations, quizzes and engaging interactions that are delivered electronically).

What is Meant by Competence?

Mastery learning assumes that all learners can become competent in the knowledge, skills and attitudes being taught, provided that sufficient time is allowed and appropriate training methods are used. The goal of mastery learning is for 100% of those trained to achieve competence—to be able to demonstrate the ability to perform the desired task/procedure/activity in a clinical setting. While some learners are able to do so quickly, others may require additional time or alternative learning methods. Individuals learn at different speeds and learn in different ways, through written, spoken or visual means. Mastery learning takes these differences into account, using a variety of teaching and training methods. It is also consistent with current, evidence-based learning principles and competency-based training (CBT).

There are different definitions for the term “competency,” “competence” and “competent.” Trainers may say, “We will train the learners to competency in inserting IUDs,” or “Through this activity, learners will build competence in performing male circumcision,” or “You will become competent in providing postpartum family planning counseling before you become proficient,” or “The learner has become competent in antiretroviral (ARV) management.”

“Competence” is the ability to perform a specific task, procedure or activity safely and effectively. A trainer may say, “You have developed a level of competence in certain skills that allows you to practice them without direct supervision.” The term “competency” defines the level of competence: “He has demonstrated competency in the desired skills and is ready to practice independently.” The term “competency” also is used to define a set of related tasks and activities required to perform a job successfully. They may say, for example, “She is able to perform the competencies required for her job.”