From learning outcomes to competencies What are they and do they reflect practice?

Learning outcomes have come to represent the building blocks
of curriculum in contemporary higher education in many western
countries. Learning outcomes, and other outcomes based
approaches such as competency frameworks, have wide ranging
implications for the design of curriculum, learning, teaching and
assessment strategies, quality assurance including comparability
and harmonisation of qualifications across institutions and national
borders. Debate about competence, competency and competencies
has been rumbling in the health professions for decades. Some
commentators suggest it has regained centre stage in response to
criticisms from employers, regulators and the public. Indeed in the
UK competency frameworks are commonly used in health care and
applied to evidence organisational as well as individual performance.
One of the more recent criticisms of health professional education,
and in particular of nursing, is that too much importance has been
placed on the acquisition of knowledge and theory to the neglect of
performance. This has particularly significance when set against a
health care industry undergoing enormous change. The penetration
of independent providers of health care into social medicine systems
such as the UK National Health System; the impact, and often
confounding, influences of evidence based medicine, technology
and performance management on care delivery; and an increasing
mobile global health care workforce places ever greater necessity on
a common understanding, if not currency, of qualifications. Similar
economic and technological drivers have impacted on education
providers and in part the learning outcomes process can be seen as
an attempt to exert control on curriculum design and delivery in order
to assure the nature and quality of the product from higher education
institutions. This inevitably exerts a number of tensions both at a
philosophical level and managing the quality control and surveillance
required to ensure concordance. Learning outcomes and
competency frameworks are therefore now viewed as the building
blocks of transparent systems and processes, not just for individual
educational institutions providing modules and programmes, or
health care providers but they are also fundamental at national and
international levels (Adam 2004, Cowan et al 2005, EONS 2005).