A series of recent reports call for the development of new competencies for health care. But how does one assess competency and, even more fundamentally, what does it mean to be 'competent'? Medical schools and licensing agencies are confronted daily with the task of evaluating and certifying professional competence using a set of practices and technologies that have evolved over time. The Competency Project seeks to foster foundational inquiry into the components, cognitive and interactional, underlying such assessments of professional competence. Our interest is in unpacking what is actually measured in consequential practical exams widely used in medical education and licensure. Becoming more articulate about what we mean by clinical competence may lead to suggestions for improving both professional training and its assessment. Subjects, medical students and residents participating as paid volunteers, will be asked to interview and examine a standardized patient (SP) who will be trained to present a case taken from psychiatric practice. Afterwards, they will construct a SOAP (Subjective and Objective findings, Assessment, and Plan) note at a computer station and will participate in a debriefing interview. We will build a collection of samples of graded practice by applying standard methods of assessment for performance-based assessment to the data gathered from the subjects' encounters with the standardized patient. Under the scope of this R03 proposal we seek funding to achieve the following specific aims: 1) To expand our existing collection of graded professional practice by (a) developing a new case in psychiatry, (b) training a standardized patient (SP), and (c) running a set of subjects and 2) to evaluate several promising analytic frameworks for studying this pilot data. Three specific frameworks will be evaluated: an analysis focusing on reasoning patterns (Cognitive Protocol Analysis), an analysis focusing on the sequential organization of the talk (Interactional Analysis), and an analysis that blends the study of cognition and interaction while focusing on knowledge structures (Cognitive Discourse Analysis). ? ? ?
