Stages of Professional Mastery

Educational Assessment - Stages of Professional Mastery
Non-Readiness Novice Advanced
Proficient Expert

Unaware of the existence or relevance of knowledge or skill

Unaware what knowledge and skills are deficient

May deny relevance or usefulness of the new skill

Attempts to determine level of knowledge and skills required to become competent.

Begins to acquire knowledge and skills

Expected to recall and understand knowledge presented in class.

Expected to be able to imitate basic skills observed in practice.

Makes commitment to learn/practice applying knowledge to move to a more advanced stage.

Lacks confidence in ability to perform independently (struggles to retrieve information and utilize skills).

Begins to acquire, remember, and understand knowledge and information within the discipline.

Begins to practice applying knowledge in problem sets and structured exercises (can solve well-defined problems); students may require scripts to perform well.

Struggles to apply knowledge to unfamiliar situations (may not be able to solve ill-defined problems).

Performance is inconsistent and inefficient.

Unable to self-correct; feedback and close supervision is required.

Lacks confidence in ability.

Familiarity with knowledge acquisition and skills develops through practice and repetition.

Can apply knowledge and skills to analyze and solve routine problems.

Mistakes are fewer; major mistakes do not occur, but the student may require supervision to refine their ability to acquire knowledge and solve complex problems.

Begins to develop confidence in ability to apply knowledge and skills to solve routine problems.

Through reflection and introspection learner recognizes knowledge and skill deficits.

High level of proficiency.

Can apply knowledge and skills to analyze and solve routine and complex problems.

Mistakes are few and learner can function with minimal supervision.

May seek feedback from preceptor with specific questions about performance.

Capable of demonstrating skill to a less experienced learner.

Aware of limits of knowledge and skills.

Consciously aims at applying “the correct” skills and knowledge to problems preferring tried and true methods rather than novel solutions

Efficient and confident in ability.

Unconsciously skilled
(skill has become “second nature”)

Adopts a contextual approach to problem solving, understanding the relative non-absolute nature of knowledge

Understands that theories reflect a certain perspective and hence the relativity of knowledge

Solves problems by continuously creating new principles based on changing circumstances rather than applying a set of absolute principles or standards across contexts and

Concerned with continued professional development

Knows what knowledge to use, what skills to employ, and when it is appropriate to do so.

Extensive experience and expertise that comes from practice

Confident in ability

Can serve as preceptor or best practice example for less skilled learners.

Professional Development Framework

In order to master the school's educational outcomes, student pharmacists will pass through a number of developmental stages. The goal in professional education is not merely to obtain a passing grade or to compare one's performance with the performance of others (as when grading is done on a curve). Rather, the goal is to attain a level of proficiency that allows one to apply knowledge and skills automatically and effectively as a practitioner in real world situations. Such proficiency, however, does not occur instantaneously. Listed below are several key stages that learners typically experience as they work toward development of professional mastery. These stages have been developed by the school's faculty after careful review of the literature describing the development of professional expertise.

Non-Readiness (Unaware Incompetence)

Most commonly, student pharmacists may have the necessary prerequisites to begin learning a new skill or acquiring new knowledge but might be unaware of the particular skills or knowledge that must be applied by the practitioner in real world situations. In some cases, students will be aware of the knowledge or skill, but have little interest in acquiring it or may indicate a vague willingness to learn in the future. They may consider the knowledge or principles related to a skill as "common sense" or "common knowledge", but do not recognize the steps involved to becoming effective in practice. Often what is "common sense" is not "common practice." In order to acquire new knowledge and develop the skill, students must become aware of what they do not know and be open to learning.

EXAMPLE: Team work is a good example of a skill area that many students in the healthcare professions see as "common sense." Often these students are so focused on the mastery of scientific information and individual clinical skills that they devalue the significance of learning team-work skills. The reality is that most experienced professionals do not practice alone. They work with and supervise technical support staff (technicians) and interact daily with other healthcare practitioners

Novice (Aware Incompetence)

In this phase, learners have the necessary prerequisites to begin learning a new skill or acquiring new knowledge. While they may continue to be unaware of the particular skills or knowledge that must be applied by the practitioner in real world situations, learners indicate an interest and willingness to develop the necessary skills and knowledge. They may have work experience though often cannot see how professional knowledge and skills contribute to professional competence. Learners who reach this stage begin acquiring new knowledge and skills within a structured framework. They are expected to be able to recall the knowledge presented in class but lack the ability to apply theoretical principles. They can however imitate some of the skills they observe during their clinical experience.

EXAMPLE: In order to be admitted to pharmacy school, students complete courses in algebra, trigonometry, and calculus in high school or college. Most have earned high marks in these courses. However, many students are unable to apply previously learned math concepts to solve simple problems that practicing pharmacists and scientists face in everyday practice. At this point, students realize that, although they have the basic knowledge and skills and the willingness to solve the problems, they lack the expertise to apply the skills in practice. Students in this phase are expected to observe experienced practitioners at their clinical sites in the hope that students will copy effective behaviors and skills and avoid ineffective behaviors. They may for example, observe a practitioner who calms an angry patient then attempt to imitate and repeat the observed patient interaction.

Advanced Novice

Learners in this stage comprehend objective facts, initial concepts, and specific rules and are able to apply them within a discipline or in structured settings but may struggle to apply them to real world situations. Learners may be comfortable solving routine well-defined problems but may be ineffective and inefficient in manipulating knowledge in unfamiliar settings or in solving ill-defined problems. Because the skills required to do so are unfamiliar to them, they may not be aware of specific mistakes made. Therefore considerable coaching and redirection may be needed to help them to correct mistakes. Students in this stage lack confidence in their ability and knowledge base and often require specific instructions or rules and may bring along "cheat sheets" and scripts to help them practice skills and solve problems. Their "rule-governed behavior" in the clinical setting limits their ability to address complex problems. Generally, students are aware that considerable knowledge and practice is required to become an expert practitioner and through practice and repetition they strive to become more efficient and precise when solving problems.

EXAMPLE: In pharmacy education, laboratories, simulations and training aids are often used to help student pharmacists apply knowledge and put theory into practice. Students learn "the basics" in class but struggle to apply what was covered in class to a real world setting. While practicing the skills needed to apply knowledge, learners may feel the need to have a script or notes handy in order to make sure that the steps needed to perform the skill are correct. For example, student pharmacists practice medication history taking early in the curriculum. In most cases, students bring along a script or "cheat sheet" to make sure that all of the information needed to complete the history is collected. Because students in this phase require the assurance of instructions and scripts they often complete tasks slowly and inefficiently.

Beginning Proficiency

Learners in this phase continue to practice using their knowledge and skills and may attempt to do so with or without supervision. Mistakes are less frequent and individuals are generally able to recognize and correct mistakes. Supervision can be provided at check points and is generally used to refine acquisition of knowledge and performance of skills rather than correct major mistakes. In this stage learners are taught more sophisticated rules and can recognize facts and elements important to the field independent of their classes. They begin to use their knowledge automatically and routinely to analyze problems and develop solutions. Their grasp on principles is strengthened through practice in class and clinical settings. Learners are more consciously aware of how their actions may lead to long-range goals or plans. At this stage they can recognize knowledge and skill deficits through reflection/introspection and can independently seek the necessary resources to address the deficiencies. Through practice and repetition they develop confidence in their ability to solve well-defined problems. Learners may be efficient in completing routine tasks but inefficient in solving ill-defined problems.

EXAMPLE: In pharmacy education, supervised clinical or laboratory training (e.g., experiential learning, clerkships, summer research programs, and internships) and involvement in student professional organizations are often used to further learning during this phase. Students develop confidence and ability as they develop proficiency in acquiring information to practice the required skills. Through repetition and practice, students learn to correct mistakes and are able to reflect and learn from their performance. For example, students who work in a research laboratory may learn to perform analytical procedures efficiently and reliably through practice, repetition, and feedback from their supervisor. At first they may require close supervision but eventually may be able to perform procedures independently in the laboratory.

Proficient (Aware Competence)

Learners in this stage have achieved a high degree of proficiency in the acquisition of knowledge and application of skills and are consistently able to meet specified performance criteria. Learners have developed a "working knowledge" of theory and are able to accurately provide evidence when applying principles to unstructured settings. In this stage student pharmacists can use their clinical and scientific expertise to articulate evidence-based recommendations. Consistency in performance distinguishes this phase from the previous phase; supervision is minimal and preceptors and supervisors may treat the student more like a co-worker than student. The learner may seek feedback from preceptors and instructors to refine fine points of performance rather than correct major errors. Learners are aware of, and capable of, defining their knowledge and skill deficits and can acquire new knowledge and skills outside of the classroom. Student pharmacists at this stage of development are capable of solving ill-defined problems based on knowledge gained and may be able to demonstrate basic skills to less experienced learners. Learners are consciously aimed at applying "the correct" skills and knowledge to problems preferring tried and true methods rather than novel solutions. Self-confidence characterizes this stage.

EXAMPLE: In pharmacy education, students demonstrate the ability to use practice skills and solve drug-related problems during supervised clinical clerkships. Some schools utilize patient simulators (actors), paper and pencil competency examinations, or structured clinical exams (OSCEs) to determine whether students have reached this stage of professional development. Successful completion of the NAPLEX and MJPE exams is the mechanism through which students demonstrate their proficiency. If the student fails to pass the exam, then they continue in the competent phase.

Expert (Unaware Competence)

Learners have met the necessary performance criteria and are flexible in their approach to solving problems in the field. Experience plays a large role in recognizing problems and developing solutions. The practitioner is concerned about continuing professional development and seeks opportunities to hone old skills and learn new ones. Reflection comes naturally and experts solve problems almost unconsciously. "Experts" adopt a contextual approach to problem solving and understand the relative, non-absolute nature of knowledge. This ability distinguishes the "expert" from the "proficient" practitioner. The expert is aware that theories reflect a particular perspective and hence understand the relativity of knowledge. The expert solves problems by continuously creating new principles based on the changing circumstances of their lives rather than applying a set of absolute principles or standards across all contexts and circumstances. Experts are "problem finders". They are able to generate new problems by examining situations from novel and creative points of view.

Mastery of a skill in a classroom situation is not the same as mastery of a skill in a practice setting. It is not unusual for learners to reach mastery in the classroom, but function at a competent level in the real world. This apparent "regression" often occurs because skills are often taught in isolation in the classroom, but must often be used in conjunction with several other skills in practice. Knowing what information is needed and which skills to integrate and having them mesh smoothly differentiates the expert from the novice. Novice professionals who keep this dynamic interaction in mind can become more proactive in their learning by asking questions, seeking feedback, or arranging for additional instruction.

EXAMPLE: The case example cited below is a great example of this level of mastery: Chisholm CD, Croskerry C: A case study in medical error: The use of the portfolio entry. Acad Emerg Med 2004; 11:388-392.

This handout was originally prepared by Maria Piantanida, Ph.D. based on a document, "A Mastery Model of Evaluation as a Strategy for Developing Professional Teaching Competencies,", revised by a University of Pittsburgh student/faculty task force (2006), and adapted for use at D'Youville College by incorporating Doggett's Rigor-Relevance Framework, elements of Bloom's taxonomy, and theories on the development of competency.

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