From the Educational Bench to the Clinical Bedside: Translating the Dreyfus Developmental Model to the Learning of Clinical Skills

TLDR

The ACGME Outcome Project has shifted resident education toward competency‑based outcomes, prompting interest in the Dreyfus model for assessing skill acquisition, yet consensus on its adaptation to clinical medicine remains lacking. The authors aim to integrate prevailing beliefs about learning clinical medicine into a coherent developmental framework based on the Dreyfus model. They translate learner characteristics and skills at each developmental stage into typical patient‑care behaviors within the general domain of patient care. The model is illustrated with snapshots of learner performance across stages, its limitations—particularly expert behaviors—are discussed, and the authors argue that descriptive developmental models support competency assessment.

Abstract

The Accreditation Council for Graduate Medical Education Outcome Project has shifted the focus of residents' education to competency-based outcomes of learning. The challenge of meaningful assessment of learner competence has stimulated interest in the Dreyfus and Dreyfus Model, a framework for assessing skill acquisition that describes developmental stages beginning with novice and progressing through advanced beginner, competent, proficient, expert, and master. Many educators have adopted this model, but no consensus about its adaptation to clinical medicine has been documented. In this article, the authors seek to integrate generally accepted knowledge and beliefs about how one learns to practice clinical medicine into a coherent developmental framework using the Dreyfus and Dreyfus model of skill acquisition. Using the general domain of patient care, the characteristics and skills of learners at each stage of development are translated into typical behaviors. A tangible picture of this model in real-world practice is provided through snapshots of typical learner performance at discrete moments in time along the developmental continuum. The Dreyfus and Dreyfus model is discussed in the context of other developmental models of assessment of learner competence. The limitations of the model, in particular the controversy around the behaviors of "experts," are discussed in light of other interpretations of expertise in the literature. Support for descriptive developmental models of assessment is presented in the context of a discussion of the deconstructing versus reconstructing of competencies.