Defining and assessing competence: the distraction of outcomes and the importance of educational process.

The concept of competence is in common usage in various areas of education and training at present, and it is evident from these different usages that it has a variety of meanings. These meanings are explored, with particular attention being paid to the increasing influence of the National Vocational Qualification (NVQ) initiative and the rise of vocational education. It is concluded that the utilization of competence within these fields offers little to nurse/midwifery education (with the exception of a refocusing on the concept of skills) because it is exactly that: education, and is therefore different in some significant aspects from training and vocational approaches. It is suggested that a holistic conceptualization of competence is the most appropriate for nurse/midwifery education: one that empowers students and practitioners, facilitating critical thinking, rather than emphasizing, as the NVQ initiative does, outcomes over the importance of educational process and the use of a variety of forms of knowledge in practice. It is acknowledged that there is probably a skills deficit in some areas of nursing/midwifery education, although definition of this term 'skills' remains problematic, and that this should be addressed through the increased use of skills laboratories.