Jean-Marie De Ketele

CanMEDS and other "competency and outcome-based approaches" in medical education: clarifying the ongoing ambiguity.

We read with much interest the papers and comments recently published in the journal (Whitehead et al. 2011a, b; Malone and Supri 2012; Sherbino et al. 2011), which brought an insightful contribution to the wide debate on pedagogical initiatives pertaining to the concept of competency in medical education. In his editorial comment, Norman (2011) highlights the necessity for questioning the relevance and the limits of the competencybased approach. This is particularly imperative for professional frameworks whose inherent nature suggests that they be implemented and standardized at a national level, as it is the case with the ACGME framework in the United States, the ‘‘The Scottish Doctor’’ and the ‘‘Tomorrow’s Doctor’’ in the United Kingdom and, in particular, the CanMEDS framework in Canada. The latter in particular has a major influence in several countries and is a topic that has been addressed in several published papers. The competency-based approach is generally well understood and accepted as a newly emerging conceptual framework amongst professionals and researchers involved in medical education. We reckon it can offer a very important opportunity to improve health

Analysis of adequacy levels for human resources improvement within primary health care framework in Africa

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:- adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations,- adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations,- adequacy between human resource management within health care system and medical standards,- adequacy between human resource management within education/teaching/training and needs from health care system and education sectors,- adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body,- adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...).This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

A comprehensive competence- based approach in curriculum development: Experiences from African and European contexts

Objective: To describe the methodological steps of developing an integrated reference guide for competences according to the profile of the healthcare professionals concerned. Design: Human resources in healthcare represent a complex issue, which needs conceptual and methodological frameworks and tools to help one understand reality and the limits of one’s acts. Setting: This study uses results from four contexts (Belgium/Europe, Democratic Republic of Congo, Rwanda and Senegal) in which integrated reference guides for competences for healthcare professionals have been developed. Method: Priority was given to the writing of curricula (initial training) or of training plans (continuous training) more effective in terms of professionalization and more adequate to populations’ needs. Results: Pedagogical approach is presented as some (step-by-step) methodological guidance which will help one to get acquainted with this approach. This analysis questions the whole issue of healthcare training institutions’ social responsibility. Conclusion: The products obtained (ie reference guides for competences) are only the visible part of the results of the far more fundamental change process that is the real reinforcement of competences and capacities of healthcare professionals in organizations aiming at better managing their resources, among which are human resources in healthcare.

L'évaluation de la qualité de la formation et du système d'évaluation universitaire: le point de vue des diplômés

Research on the assessment of the professional abilities of higher education graduates (ROMAINVILLE, 2002; DE KETELE, 1997, 1999, 2000; FRANCE, 2003; Opinion of the High Council of the evaluation of the school, 2003) focuses on four issues: skills that students have prior to their higher education studies; students perceptions of acquired skills at the end of their studies; transferable skills and the higher education effectiveness on developing professional skills. However, few studies provide good indicators on the measured professional skills and on which criteria will be assessed by the job market. In this study, graduates who are active in the job market evaluate retrospectively the quality of their academic curriculum. The results of questionnaire taken by 158 graduates showed the universitys difficulty to implement a relevant and valid assessment system that promotes the development of the necessary professional skills.