Assessing competence for registration in the healthcare professions : the experiences of dietitians and their students

Over the past twenty years a range of diverse and sometimes competing political, economic and professional drivers have been forcing significant change in the education of United Kingdom healthcare professionals. These drivers have emphasised the importance of practical competence for the workplace and this in turn has placed a stronger emphasis on the assessment of competence in practice. The need for strong public accountability and maintenance of the standards and status of the professions has tended to emphasise a technical rational approach to assessment, where standards are pre-defined in detail and assessment is based on replication of the prescribed behaviours under reasonably standard conditions. At the same time the need to develop professionals with the skills and confidence to function in an autonomous and self-directed way has demanded the use of strategies that embrace reflection and self-assessment and test students' skills in relation to professional judgement. The work I have presented here encompasses four studies, which shed light on the tensions that exist in relation to the need to promote strong governance and accountability at the same time as self-direction and offer an insight into how healthcare professionals have tackled this challenge. Taken together my findings have enabled me to describe an approach to assessment that centres on dialogue as the key tool for addressing this challenge, ensuring development towards autonomy and effective governance throughout the student's journey to registration. My work is focused on the assessment of competence in dietetic practice but the findings have been applied both at a micro-level at the sites where the work was carried out and at a macro-level within dietetics across the UK and interprofessionally