Conceptual framework for performance assessment: competency, competence and performance in the context of assessments in healthcare--deciphering the terminology

Med Teach. 2012;34(11):920-8. doi: 10.3109/0142159X.2012.722707. Epub 2012 Oct 8.


Background: The definitions of performance, competence and competency are not very clear in the literature. The assessment of performance and the selection of tools for this purpose depend upon a deep understanding of each of the above terms and the factors influencing performance.

Aim: In this article, we distinguish between competence and competency and explain the relationship of competence and performance in the light of the Dreyfus model of skills acquisition. We briefly critique the application of the principles described by Miller to the modern assessment tools and distinguish between assessment of actual performance in workplace settings and the observed performance, demonstrated by the candidates in the workplace or simulated settings.

Results: We describe a modification of the Dreyfus model applicable to assessments in healthcare and propose a new model for the assessment of performance and performance rating scale (PRS) based on this model.

Conclusion: We propose that the use of adapted versions of this PRS will result in benchmarking of performance and allowing the candidates to track their progression of skills in various areas of clinical practice.

MeSH terms

  • Behavior
  • Clinical Competence*
  • Employee Performance Appraisal / organization & administration*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Staff Development
  • Workplace