ABSTRACT
This chapter will attempt to assess the way in which the medical profession and patients define, determine, regulate and evaluate competence as a key part of the professional identity of doctors. The concept of competence is both multidimensional and remains ambiguous, which makes any analysis of this issue problematic. Furthermore, it has numerous synonyms such as sufficiency, capacity and adequacy, none of which quite tap the subtlety of the actual concept of competence as applied in professional quality assurance. Moreover, the concept gets expanded to cover new areas such as the current interest in cultural competence. As a consequence, much has been written about a ‘competency-based medical curriculum’. Many professionals attempt to instil, by formal and informal socialisation and education, a certain degree or level of competence in a large number of specific, profession-related skills. These skills are usually assessed by a formal examination. The central question is which skills, and how best to instil and measure them. There are essentially three ways of teaching/training people: classroom/ward teaching using traditional teaching methods; active learning through practice and assignments; and personal coaching. We are now also seeing the emergence of e-learning and teaching. Most doctors are trained by all four methods. One question for those in medical education is how to use different methods to achieve maximum competence at minimum cost to the taxpayer. This question is at the heart of the issue of professional identity in medicine for academics, politicians and members of the general public.
