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Final Report > Chapter 25: Competent Healthcare Professionals > Broadening the notion of competence

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Broadening the notion of competence

8 Clearly, healthcare professionals must be technically competent to do the task they profess to do, but technical competence is no longer sufficient, if indeed it ever was. A major lesson of our Inquiry is that there are a number of non-technical, non-clinical skills of doctors, nurses and managers which are crucially important to the care of patients. We have identified six key areas. They appear to have been relatively neglected in the education and training of healthcare professionals in the past. They must not be in the future. They are:

  • skills in communicating with patients and with colleagues;
  • education about the principles and organisation of the NHS, how care is managed, and the skills required for management;
  • the development of teamwork;
  • shared learning across professional boundaries;
  • clinical audit and reflective practice; and
  • leadership.

9 Clinical skills are essential, but patients are entitled to expect that the healthcare professionals caring for them will also possess these non-clinical skills. Education and training in them must be accorded a greater priority in the future and this should apply at all stages of a professional's career: education, training and continuing development. Healthcare professionals cannot fulfil their responsibilities without having these skills. In the case of doctors we are aware that ever since the Todd Report in 1968 [5] a range of non-clinical subjects have been taught in medical schools. But, with notable exceptions, it is sadly the case that these subjects (for example, communications, medical sociology, or health and society) have not been accorded the importance they require. Whereas students are increasingly examined in them, the problem remains that they are dismissed as having a low status by those who teach basic sciences and this attitude rubs off on the students.

10 Education in the areas which we have highlighted must become fully integrated into the undergraduate curricula of relevant courses. They must be much more than mere `add-ons', tolerated as extraneous burdens on what some might see as the `real' clinical curriculum. It is in the formative years of undergraduate education that attitudes are forged and skills imparted which shape the quality of engagement with patients for years to come. Efforts to improve and expand professional competence through undergraduate education, however, will only succeed if the skills of newly qualified professionals are reinforced throughout professional life and also valued by those currently in senior positions. That is why we argue that these six areas must also be given a high priority at all levels of professional preparation and training. They should also form part of the plans and practices of NHS employers for the continuing professional development of their employees.


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[5] Lord AR Todd. `The Todd Report' (1968). Royal Commission on Medical Education. (Cm. 3569)