Professions, Competence and Informal Learning

Citation

Aherne, M. (2006), "Professions, Competence and Informal Learning", Leadership in Health Services, Vol. 19 No. 2, pp. 29-34. https://doi.org/10.1108/13660750610665017

Professions, Competence and Informal Learning is an effort by UK based scholars Graham Cheetham and Geoff Chivers to help “… unravel the complex issues of professional competence and of how this can be acquired” (p. 283). It is intended for a wide readership of those charged with better understanding and developing professional development programs. It will be of interest to those working with a range of disciplines.

The book provides an in‐depth synthesis of continuing professional development (CPD) and adult learning literature. It brings into focus a myriad of published work from disparate sources. The authors try to guide the reader through the complexity of modern professional practice, while providing detailed information about professional competence and informal strategies for developing competence. The book is also a vehicle to present the authors’ original research and propositions.

The original research was undertaken in a UK context. It sought to address characteristics of modern professions; the nature of professional competence and practice; how competence is conceived by practitioners; forms of informal learning and validation of the authors' proposed model. The research involved in‐depth interviews with 80 practitioners from 20 fields, a descriptive mail survey of 720 practitioners (52 percent usable responses), descriptive surveys of acknowledged experts/authority sources in continuing professional development (CPD) and feedback generated by early work published in the Journal of European Industrial Training.

The book is organized into four parts. The first is an attempt to define professions and situate professions and professional practice in a British historical and sociological tradition, which is acknowledged as being dominant for many industrialized countries. The second examines concepts, constructs and key programmatic problems of 20th century approaches to professional competence. It also presents the authors' model for professional competence. Part three delves deeper into published CPD theory, particularly the myriad understandings of how skilled practitioners continually build on their knowledge and skill base.

The last part of the book presents many contemporary issues facing professionals and those charged with leading CPD. These issues include epistemological ones about the legitimacy of professional knowledge and professionals' ways of knowing (e.g. evidence‐based practice versus practice‐based evidence); regulatory dimensions of competence and CPD; input and performance‐based CPD; and supports for practitioners which reflect the demands of the environments in which they practice. This section also presents a critique of a disproportionate volume of adult learning and CPD literature as being US‐based. Caution is urged by the authors, in the universal application of the current published literature base as much of it may be culturally bound. The book has appropriate appendices to support the critical reviewer of the original research as well as a reasonably comprehensive bibliography.

The cultural critique of scholarship is important. It could be extended to note the majority of current CPD scholarship emanates from British as well as American sources. There is currently a dearth of linguistically and culturally accessible literature in CPD generally, which also poses a challenge in informing CPD for health services in pluralistic societies. The authors' critique is a reminder that professions now operate within a global space and professionals are challenged by the paradox of having to respond locally to a range of cultural expectations fueled by globalization, within an emerging paradigm of cultural competence.

Critically reading through the interpretative lenses of a scholar‐practitioner who has designed and managed performance‐based CPD of regional, national and international scope in energy and health sectors over the last 15 years, Professions, Competence and Informal Learning has mixed utility. It is helpful, particularly around the authors' attempts to propose a Taxonomy of Informal Learning Methods, but should be used with caution by the newcomer to CPD and professional competence.

The inclusion of the historical and sociological foundations of professions and professional practice may seem novel, but is important. Too often those charged with supporting professional competence do so without adequate grounding in the socio‐historical context of the discipline they are assisting. This section is a welcomed inclusion about the foundations of professions. It can be especially useful for those in health services who are attempting to unravel contemporary issues associated with interdisciplinary practice and multi‐professional CPD.

Many of the challenges with which established professions in modern societies present, medicine and the clergy in particular, have deep roots in the historical context from which they have evolved. A deeper appreciation of how institutionally vested expert knowledge has emerged, including traditional roles and power relationships within a society, can provide valuable change management planning information. This is essential for informing understanding and leading change in a contemporary context of comparatively well‐educated, reluctantly empowered modern consumers and multiple disciplines and professions competing for status and role clarity. The changing power relationships associated with disruptive technologies such as the Internet and personal computing power, which are popularizing many domains of knowledge, drives many of the challenges associated with professional competence and learning. Knowing where a profession's culture has come from is vital to inform how it might be guided in response to larger changes in the macro socio‐political/economic environment.

The attempt to define what a profession and professional is, is admirable but riddled with philosophical and practical problems. It results in a lack of conceptual clarity. This is a cause of significant concern for the uncritical reader who might accept it as factual. It focuses the discourse of professions and professional competence largely around an “expert knowledge” paradigm as the dominant and important characteristic of professions, not withstanding a stated intent to find a reasonable middle ground between technical‐rational and reflective practice (i.e. more constructivist) paradigms. The authors call this middle‐ground “technically grounded extemporization.” A careful read also highlights definitional challenges and complexity, which speaks to the growing popularizing, and resultant democratization, of a range of previously specialized knowledge. For those working with health science practitioners this definitional issue is particularly problematic.

The emphases on specialized content knowledge and skilled application to a focused set of tasks as the basis for professional competence masks deeper societal challenges faced by modern practitioners. Competent professional practice, for instance, has become much more than how skillfully a surgeon performs in the operating theatre. It also relates to how well that surgeon establishes a functional therapeutic relationship with a patient and family, how the practitioner‐patient relationship is negotiated to assure appropriate disclosure, autonomy and consent in decision‐making, how difficult ethical and relational conversations are respectfully navigated, and how concerns and complaints are adequately addressed.

One does not get the sense from the discussion of issues in the book that the authors are in touch in a visceral way with the contemporary struggles underlying the relationship with health science professions and citizens (Baskett and Marsick, 1992). This is one largely of choice, relationship and decision‐making power amid practice contexts of profoundly strained resources, especially those of publicly funded health delivery systems (Aherne et al., 2001). What the reader receives instead is a safe exposure to definitions grounded in the application of expert knowledge. This approach seems out of touch with the realities of many profession regulators and the turbulent nature of many professions as they navigate a changing relationship amongst each other and with society. It seems the authors are describing processes of codifying and professionalizing expert knowledge, which has otherwise been described as the emergence of knowledge work and the rise of the knowledge worker (Drucker, 2002; Reich, 2000).

For those working with health science professions, this book illustrates some profound challenges of contemporary practice by what it does not address. It is written with an underlying “rational actor” assumption, which is characteristic of the technical‐rational paradigm being critiqued by the authors. That is, the idea that all other things considered, intelligent, well‐educated people working in professions will behave as rational actors. The book lacks a substantive discussion of the political nature of professional competence amid the profound societal, technological and economic challenges facing contemporary professions (Cervero et al., 2001).

These myriad challenges are driving a redefinition of competence constructs and underscore why informal and incidental learning are becoming central features for consistent professional performance. These are often relational, ethical, organizational and political challenges which have been described by others as “wicked problems” (Rittel and Webber, 1973). The authors discuss the idea of professional ethics as one of the “facets of competence,” but the idea is never developed with an emphasis, which is commensurate to the challenge it presents in practice. The book would be better‐balanced and more useful with presentation of broader constructs of professional competence which address more fully the relational, ethical, legal/regulatory and political dimensions that are preoccupying the current governance discourse of professions.

For example, the UK's, National Health Service (NHS) has seen the rise of consumer power and rights, including formalized processes for citizens to express concerns and complaints about professional services received (UK National Health Service, 2006). This change shifts power. It demands providers be more open, transparent and accountable. Citizen‐consumers have unprecedented status in the how they engage and are engaged by health delivery systems. In Switzerland, the recent sanctioning by the governors of the University Hospital in Lausanne to drop previous policy barriers to enable requests for provider assisted suicide as afforded by Swiss law (Williams, 2005), illustrate the most pervasive competence challenges today for professions in health are those intersecting with safe, ethical, effective and defensible practice.

Moreover, the issues of professional competence of most pressing concern to regulators looking at cross‐border migration of health professionals quickly transcend the domain of technical skill and move into the realm of relational, ethical, quality and other performance‐related issues. While briefly mentioned in passing, as though more of a cursory, detailed and systematic inventory of issues affecting professions, ethical dimensions of professional competence are largely discounted by the expert knowledge approach as presented by the authors.

Borrowing from the authors' own discussion and critique of Schön (1983) work on the Reflective Practitioner concept, it appears they have approached the writing of the book from a “high ground” view of professions as expertise‐based, skilled technical domains rather than the “murkiness of the swamp.” As Schön noted so vividly with this metaphor, down in the swamp where most regulated professionals operate, there are few clear‐cut answers amid too much work, comparatively few resources, difficult ethical dilemmas and too little time.

The difference between professions and knowledge work seems to be largely defined by the artistry in navigating difficult ethical, moral and practical dilemma's that tend to set aside “wise action” in professional practice from highly‐skilled knowledge work. The reader simply does not get this sense from the authors. It leaves the reader interested in working in a health services context with an incomplete sense of what is required to support health science professions in a time of profound change.

The stated scope of the book as principally interested with informal learning and development interventions of the individual neatly side steps the organizational and societal dynamics in which practitioners must operate daily. This is somewhat convenient for analytic purposes, but not particularly helpful when society judges one by actual performance and not by competent potential. Nowlen (1988) work, which examines practice setting/work environment variables as potentially impeding professional performance for the otherwise competent practitioner, may be a more helpful way of balancing some of the shortcomings of the authors' approach when it comes to applying the ideas of the book in practice.

The dominant focus on the expert‐knowledge view of professions might also help explain the notable absence of scholarship on transformational learning (Mezirow et al., 2000), emerging insights on professions ways’ of knowing and being (e.g. including Emotional Intelligence) as well as intellectual traditions that play an important role for informing contemporary professional practice (e.g. feminist theory; womens' ways of knowing; traditional cultural/indigenous knowledge), but which are missed as evidenced by their absence.

The book is also insightful for what the well‐documented account of the contemporary range of adult education theory and foundations doesn't tell the reader about the evidence‐base. There is a well‐established tradition of theory building in adult education and CPD. What emerges is a subtext of a field desperately lacking in theory‐testing to validate its theory‐base.

One test of the perceived value of a book such as this is “would I want to keep it on my bookshelf and will I use it?” Professions, Competence and Informal Learning will have a place on my bookshelf, right next to Moon (1999), Reflection in Learning and Professional Development. The principal strength of Cheetham and Chivers' book is as a compendium and synthesis of the CPD and professional competence literature, and as a repository of ways for developing proficiency and expert knowledge using a wide repertoire of tools and interventions. They have accepted a daunting task. They make an important contribution, but without a desire or willingness to enter “the swamp of professional practice,” the book ought not to be used as a sole or definitive authority source on the messy modern business of professions, professional competence and learning, especially for health service leaders.

Michael Aherne is a Certified Management Consultant (CMC) with a specialized practice in Continuing Professional Development. He is a former Research Associate of the University of Alberta's, Institute for Professional Development and is Director, Initiative Development for the Canadian Pallium Project.