The Evolution Of Competency-Based Learning In Healthcare
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What You Need to Know About Competency-Based Learning In Healthcare

We have all spent time in a classroom staring at a professor writing on a board and wondering how, by any stretch of the imagination, the concept we are busily cramming into our brains will ever be of use to us. It can be a frustrating experience. Who, then, will actually take the time to step away and engage in traditional learning when they are on the job? Not many. And that is OK, because it turns out, busy professionals do not learn as effectively in classroom settings as they do when presented with information that is directly relevant to what is facing them on the job. With the availability of information today, busy professionals want to learn just-in-time to solve the problem at hand.

eBook Release: Competency Based Learning in Healthcare Organizations
eBook Release
Competency Based Learning in Healthcare Organizations
Discover what Healthcare organizations stand to gain from Competency-Based Training, and how the CBT movement has begun to make the workforce more relevant.

But job-based training has traditionally been very dry. Vocational training is often seen as job-task training, devoid of creativity, and higher level problem-solving skills. Healthcare facilities employ a variety of clinicians and a good portion of them spend thousands of hours and tens of thousands of dollars building the higher level critical thinking and creativity skills that vocational training seems to remove from the picture.

Competency-Based Training (CBT) is thus an evolution of the original thinking around vocational training which incorporates higher level thinking and creativity.

The CBT movement began to make the workforce more relevant. Globally, countries like the US, New Zealand, and the UK began to gather skill requirements into groups and linked them to desired outcomes. The definitions of these outcomes are what we refer to today as competencies. On the face of it CBT may seem like the same dry, creativity-free training zone that most people spend a lot of time trying to avoid but that is no longer the case. Fast forward to today’s landscape, and let’s talk about why the Competency-Βased Training & Learning movement is gaining in popularity.

The New Competency-Based Learning In Healthcare

The idea of measuring learning by evidence-based criteria is very attractive. In Healthcare, this popularity is partly fueled by the natural alignment between systems that measure the effective outcomes of a learning exercise as proof that it is part of the process to get paid for providing patient care. Said another way, how can prove that the training we provide to Healthcare clinicians is actually improving patient outcomes? Competency-based training (or learning from the perspective of the clinician) helps to achieve this.

So what is the new competency-based learning in Healthcare? Like any popular methodology, there is a broad number of pieces to the definition. Some are as dry and devoid of creativity as you would imagine. Other more recent definitions, however, take advantage of the adult learning trends that have been evolving in the training world and incorporate them into CBT. Take Malcolm Knowles for example, who introduced the concept of Andragogy in 1968[1]. Knowles knew that working adults—busy professionals—are motivated to learn in different ways and thus introduced the tenants of Andragogy.

The Evolution Of Andragogy To CBT

The tenants of Andragogy are simple. Adults are motivated to learn when they are facing a problem. They go looking for learning moments in the context of need and want only the information necessary to solve that problem at hand. Additionally, adults are self-empowered. They know that they are the only person who truly understands what they need to learn. Malcolm Knowles laid this out in his 1973 publication, The Adult Learner: A Neglected Species[2]. He also highlighted that adults are self-directed and want to be responsible for the outcome of applying learning to real problems. Adults inherently learn through application of knowledge and evaluation of the results – trial and error. Busy professionals are interested in just-in-time solutions. They want you to tell them only what they need to know at the moment that they need to know it so that they can apply it to the problem at hand and achieve desired outcomes. The sum of their learning then comes in chunks or modules that eventually form into an aggregated competency.

You can see the influences of Andragogy in the following three tenants of modern day CBT:

  1. Discrete competencies directly related to the work of an individual are measured using evidence based criteria
  2. Instructors are facilitators and not presenters in the process of teaching and measuring
  3. The learner is engaged in a self-correcting process of application that leads to an outcome

Based on the foundational principles of Andragogy, competency-based learning embraces the idea that effective learning is learning that is applied to real problems. Instead of focusing on high level abstract concepts and frameworks that can be applied across multiple job contexts, the competency-based learning approach encourages teachers to take a very specific set of job related output requirements – discrete competencies – and create measurable situations where knowledge can be applied and measured to determine if an outcome has been reached.

The instructor acts more like a facilitator than a presenter. Instead of telling an individual what to do in the situation, they provide upfront guidance around how to think about and approach the task at hand. Followed by this, the facilitator then encourages learners to create their own path through the problem in front of them – a path that creates “Artifacts” that act as evidence that the learning has been correctly applied. This leads to a greater sense of confidence in the efficacy of the learning where confidence is extended to the idea that this application can be replicated to the next problem, and result in another successful outcome.

For example, in a recent article titled “Smart Jobs, Smart People” published by the Association of Talent Development, Jonathon Levy said “what is required is real-time learning: learning how to do a job while you are actually doing it, and then upgrading your skills while you are mastering the skills you just learned.” While Levy takes this to a visionary place where performance support is available every step of the way, the tenants are real today. CBT can be structured as the foundation of a learning culture that trains you on what you need to learn (input) at the time you are undertaking the new challenge to produce desired outcomes (output)—again drawing back to the idea of just-in-time competency training.

In fact, the biggest challenge to Healthcare is to create cultures that embrace the competency-based training approach. Healthcare needs to overcome the vocational training stigma that comes with an approach focused solely on discrete output. While it will take time to change the culture of learning in Healthcare, what follows is a discussion of CBT benefits that will help sway decision makers to take steps forward to make this change.

Final Word: Metaphorically Understanding Competency-Based Learning

Take the activity of fishing for example. Instead of giving the learner a description of fishing, the instructor teaches the learner to fish by explaining the steps and then standing by to answer questions as the hungry would be fisherman baits his hook and finds his own style of casting the line. The evidence of “fishing” success is measured by the instructor and the desired – did the man catch a fish? Was it the right kind of fish? Was it done in the appropriate amount of time? All measurable, all relevant to the competency of fishing, and all guided. But best of all – the man was catching fish while he was learning to fish.


  1. Knowles, Malcolm S. The modern practice of adult education. Vol. 41. New York: New York Association Press, 1970.
  2. Knowles, Malcolm. “The adult learner: A neglected species.” (1973)