What's the difference between "knowledge," "competence," "performance" and "patient outcomes"?

Published Date: 
December 18, 2009
Last Revised: 
November 15, 2011

The ACCME requires accredited providers to understand the issues with knowledge or competence or performance that underlie a professional practice gap. Problems with knowledge, competence or performance that underlie a professional practice gap — and design an educational activity to intervene — and to design and to measure — in terms of changes in competence, performance or patient outcomes. The patient outcome or the outcome is like the professional practice gap, those are analogous.

Providers ask us: First, what’s the difference between knowledge and competence, and why are you asking us to change knowledge and measure competence? So, the first definition that’s important for the ACCME to share is that our use of competence is in the educational measurement term. Competence is about ability. Competence is what you would do if you could do it. If you had the opportunity to implement exactly what it was that you wanted to do — that’s your strategy. And that would be a measure of your competence, that’s your ability. It’s not the use of competence like competencies or whether or not you’re good enough to practice. It’s descriptive of strategy. Competence is knowledge put into action; put into action by the learner. It’s: This is what I know and this is what I would do on the basis of it. That’s my competence, that’s the ability that I have and that’s what I want to express to you as a measure of my competence as a result of the educational intervention.

You put competence into action. You put it into practice — that’s performance. Performance implies in practice. Outcome, patient outcome, research outcome, executive outcome, administrative outcome — those are the consequences in the system, in your stakeholder, in the place of application of your performance. You measure those to determine the impact of the educational intervention. Does it matter if you call it performance and we call it competence or vice-versa? No. It doesn’t matter. What we want you to do is to understand those differences so that you know that measuring in practice is different than asking people what they would do if they could. Those are two different things. We call one performance, we call one competence. What we want you to do is decide beforehand what it is — well, excuse me , it doesn’t have to be beforehand — we want you to decide what it is you want to measure as a result of the educational activity. Do you want to measure their strategy, what they would do if they could?

Do you want to measure them in practice? Do you want to measure the consequences of their actual performance in practice? And you measure that. And you can call it what you want: competence, performance or outcome. That’s not what’s important. It’s that you recognize that there are differences between them. Some require being in practice, some don’t. 

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