MRCGP & GP Training

The Professional Competencies

Competencies, Skills and Capabilities

Competencies are abilities or attributes, described in terms of behaviour, key to effective performance within a particular job.  They provide a common language for describing performance and the abilities/attributes displayed by individuals. Currently the RCGP defines 13 competencies.   

Put another way, everything any competent GP does can be mapped out into one or more of these 13 broad areas (competencies).    Therefore, if by the end of training a trainee can demonstrate that they are good (i.e. competent) at all 13 areas, then it makes logical sense that they are also competent at being an independent GP.

During training, you have to pay attention to two things over the 3 years.  Cover the curriculum and build your knowledge, skills and attitudes.   And show evidence that you are competent in all the 13 professional competency areas.

​The definition of ‘skills’ and ‘competencies’ is, on the face of it, very similar. They both relate to the ability to do something well.  But competencies are not skills, although they are similar.

A skill focuses on the ability to do a particular thing.  If you are good at a skill or even a set of skills, that does not automatically mean that you will be good at a job.   That’s where competencies come in.    Competencies focus on behaviours rather than abilities and tend to be based on broad things rather than the specific things that skills focus on.  Competencies specify how the individual carries out the skills they have in the context of their working environment (s).  

For example, lets say you have 5 window cleaners who are really good at cleaning windows.   Clearly all 5 have the skill!    But if I told you two of them always turn up late and make a right mess whilst a third one is always rude and lies about the number of windows that have been cleaned – that only leaves two who have the necessary competencies making up a good window cleaner.  Those competencies might be punctuality, communicates well with clients, is ethically minded, and is honest.

So basically, competencies tell us what success looks like.   They combine ABILITY with the knowledge and skills required.  

What’s the difference between Competence and Capability?

When we say an individual is competent, we are implying that actual state that has been reached and that there is nothing further to do.   When we say someone is competent, it’s like saying they have reached a ‘defined’ state and there is nothing further.  All learning has been achieved.  There is no further learning.    Capability does not have this limitation.  Capability not only refers to whether a minimum ability exists in an individual but also provides space for further improvement.  

Here are some examples…

  • A student may be getting average grades in their A-levels.   But with more intense revision and educational input, they are capable of achieving significantly better grades.
  • A runner can finish a marathon in 3 hours and that might be pretty good.    However, with further training, they may have the capability to complete it in less than 2.5 hours.

Competence is another word describing the ‘know-how’ or ‘skill’ of an individual whereas capability is the word that describes how good they are at applying it in a variety of situations and circumstances.   Capability incorporates an individual’s competence PLUS their attitudes, values, and flex their style.   Capability is therefore a higher and more “real” indication of a trainee’s ability than competence. Capability is not just about the possession of skills (unlike competence).

This might help you understand it better…

(Taken from: Quality in Learning, edited by John Stephenson and Susan Weil, published by Kogan Page, London in 1992.  CHAPTER ONE CAPABILITY AND QUALITY IN HIGHER EDUCATION John Stephenson )

Capability: a working definition Capability does not easily lend itself to detailed definition. It is easier to recognize it than to measure it with any precision. It is an integration of confidence in one’s knowledge, skills, self-esteem and values. We have found widespread support for our resistance to the temptation to define capability in reductionist terms, seeking ever more separately measurable competences. Capability depends much more on our confidence that we can effectively use and develop our skills in complex and changing circumstances than on our mere possession of those skills. 

The following definition of capability, however, has been useful in exploring the essence of capability with academics: Capable people have confidence in their ability to

  1. take effective and appropriate action,
  2. explain what they are about,
  3. live and work effectively with others and
  4. continue to learn from their experiences as individuals and in association with others, in a diverse and changing society.

Capability is a necessary part of specialist expertise, not separate from it. Capable people not only know about their specialisms; they also have the confidence to apply their knowledge and skills within varied and changing situations and to continue to develop their specialist knowledge and skills long after they have left formal education. 

Capability is not just about skills and knowledge: it incorporates values, self-esteem and a commitment to learning.

Taking effective and appropriate action within unfamiliar and changing circumstances involves judgments, values, the self-confidence to take risks and a commitment to learn from the experience. Involving students in the decisions which directly affect what they learn and how they learn it develops a sense of ownership and a high level of motivation. 

Many academics find the emphasis on confidence, esteem and personal values as well as on knowledge and skills relevant to their perception of an educated person and the role of higher education. Each of the four ‘abilities’ is itself an integration of many component skills and qualities, and each ‘ability’ relates to the others. For instance, one’s ability to take appropriate action is related to our specialist expertise which in turn is enhanced by one’s learning from one’s experiences of earlier actions taken. ‘Explaining what one is about’ involves much more than the possession of oral and written communication skills; it requires self-awareness and confidence in one’s specialist knowledge and skills and how they relate to the circumstances in hand. 

Educating for capability through higher education 
Capability, we argue, is developed as much by the way students learn as by what they learn. If students have experience of being responsible and accountable for their own learning, within a rigourous and interactive environment, they will develop confidence in their ability to take effective and appropriate action, to explain what they are about, to live and work effectively with other people, and to continue to learn from their own experiences. The medium, as they say, is the message. The Higher Education for Capability approach is a total approach. Confidence in one’s personal qualities and specialist expertise is developed through successfully taking responsibility and accounting for the reflective application of specialist knowledge and skills. 

Let's talk about RDMp first...

In summary, the 13 competencies/capabilities can be grouped into one of the four RDMp areas.

Click on a link to read more...

  • Every part of a GP's job can be catergorised into one or more 4 broad areas.
  • These are....
    1. Relationship
    2. Diagnostics (or Decision Making)
    3. Management
    4. Professionalism
  • So, if we can define several capabilities within each of these four areas then it should make sense that if a GP trainee can demonstrate "good enough" performance in each of these capabilities by the end of their training, then they should be "good enough" to become a qualified GP.
  • These capabilities are called The Professional Competencies (but they will soon be called The Professional Capabilities).
  • Before we go onto exploring the capabilities (or competencies), click below to read more about one or more of the RDMP domains. RDMp was developed by the occupational psychologist Dr Tim Norfolk (ref: Quality in Primary Care 2009; 17, 37-47).
  • And if you want to understand more about the term Capabilities, see the toggle menu above.​

The 13 RCGP Professional Capabilities

Remember what was said earlier.  Competencies or Capabilities are abilities or attributes, described in terms of behaviour, key to effective performance within a particular job.  They provide a common language for describing performance and the abilities/attributes displayed by individuals. Currently the RCGP defines 13 competencies.   

Put another way, everything any competent GP does can be mapped out into one or more of these 13 broad areas (competencies).    Therefore, if by the end of training a trainee can demonstrate that they are good (i.e. competent) at all 13 areas, then it makes logical sense that they are also competent at being an independent GP.  During training, the trainee has to provide evidence of being competent in the 13 Professional Capability areas.   That is what they should focus on at all times.

Click on a blue link to read more...

MANAGEMENT

Please note: Primary Care Admin & IMT is now called Organisation, Management & Leadership (OML) – to embrace the skills of leadership and workload management.  

Many thanks...

Many thanks to Dr Amar Rughani for allowing Bradford VTS to use his book and making it available in electronic format for those who wish to use, copy or share it.
Dr Amar Rughani
GP (Sheffield)

Amar has dedicated most of his working life to the education of GPs and development of GP training.

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