Assessing competence for registration in the healthcare professions : the experiences of dietitians and their students

Over the past twenty years a range of diverse and sometimes competing political, economic
and professional drivers have been forcing significant change in the education of United
Kingdom healthcare professionals. These drivers have emphasised the importance of
practical competence for the workplace and this in turn has placed a stronger emphasis on
the assessment of competence in practice. The need for strong public accountability and
maintenance of the standards and status of the professions has tended to emphasise a
technical rational approach to assessment, where standards are pre-defined in detail and
assessment is based on replication of the prescribed behaviours under reasonably standard
conditions. At the same time the need to develop professionals with the skills and confidence
to function in an autonomous and self-directed way has demanded the use of strategies that
embrace reflection and self-assessment and test students' skills in relation to professional
judgement. The work I have presented here encompasses four studies, which shed light on
the tensions that exist in relation to the need to promote strong governance and
accountability at the same time as self-direction and offer an insight into how healthcare
professionals have tackled this challenge. Taken together my findings have enabled me to
describe an approach to assessment that centres on dialogue as the key tool for addressing
this challenge, ensuring development towards autonomy and effective governance
throughout the student's journey to registration. My work is focused on the assessment of
competence in dietetic practice but the findings have been applied both at a micro-level at the
sites where the work was carried out and at a macro-level within dietetics across the UK and
interprofessionally.

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