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Clinical Competence: General Ability or Case-specific?

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Abstract

Background

Before the 1970s, research into the development of clinical competence was mainly focused on general problem-solving abilities. The scope of research changed when Elstein and colleagues discovered that individual ability to solve clinical problems varies considerably across cases. It was concluded that problem solving abilities are highly dependent on domain-specific knowledge rather than on general problem solving skills. Elstein called this phenomenon “case specificity.”

Purpose

The finding of content specificity will be contrasted with the existence of a general clinical problem solving ability, and the relationship between preclinical knowledge and a problem solving ability will be investigated.

Methods

A correlation matrix was calculated with clerkship final scores from 10 disciplines to examine the magnitude of the interrelations. A confirmatory factor analysis was applied to the corresponding covariances using structural equation modeling to investigate whether scores on finals shared any common variance across clerkships. Finally, two additional models were tested to examine the nature of the relationship between preclinical knowledge and problem solving.

Results

Low to moderate correlations across clerkship disciplines were found, supporting the original findings of content specificity. Further investigation showed that in addition to specific knowledge, a general, content-independent ability is needed to perform on these examinations.

Conclusions

Clinical competence, as measured in this study, is based on a combination of specific preclinical knowledge and a problem-solving ability. Case specificity fits perfectly well in this interactional perspective on clinical problem solving but does not explain it. The phenomenon “case specificity” is therefore not solely a result of content knowledge, but of level of experience and level of case difficulty.

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Authors and Affiliations

  1. Institute of Medical Education and Research, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands

    Paul F. Wimmers

  2. University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Paul F. Wimmers

  3. Department of Internal Medicine, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands

    Ted A.W. Splinter

  4. Department of Measurement, Statistics and Evaluation, University of Maryland, College Park, USA

    Gregory R. Hancock

  5. Institute for Psychology, Erasmus University, Rotterdam, The Netherlands

    Henk G. Schmidt

Authors
  1. Paul F. Wimmers
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  2. Ted A.W. Splinter
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  3. Gregory R. Hancock
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  4. Henk G. Schmidt
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Corresponding author

Correspondence to Paul F. Wimmers.

Additional information

This research was presented at the 85th Annual Meeting of the American Educational Research Association (AERA) in San Diego, California, USA, April 12–16, 2004, with the title: How content specific is clinical competence? It received the Best Paper by an Established Investigator Award from AERA’s Division I Awards Committee.

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Wimmers, P.F., Splinter, T.A., Hancock, G.R. et al. Clinical Competence: General Ability or Case-specific?. Adv Health Sci Educ Theory Pract 12, 299–314 (2007). https://doi.org/10.1007/s10459-006-9002-x

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  • DOI: https://doi.org/10.1007/s10459-006-9002-x

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