Development from rule-based to context-based behaviours

The acquisition of skills, according to Andrews and Burruss (2004), is a developmental process, a movement from rule-based behaviours to context-based behaviours. Six stages of development are identified. The table below illustrates the description of Andrews and Burruss (2004) about the progressive development from rule-based behaviours to context-based behaviours. Rules gradually become subliminal, integrated with intuition and tacit knowledge emerges.

Andrews and Burruss (2004) argue that residents should be exposed to a variety of ways of assessing patients, diagnosing and planning of treatment. This is possible through supervisor contact with several clinicians, in different clinical settings and exposure to a spread of patients across the continuum of disease severity. They substantiate their argument by pointing out that learning theory suggests that repetition (multiple learning ways and methods), as well as timely feedback and acceptance of responsibility for one’s actions together contribute to learning effectiveness. Assessment is further an important form of learning. Four levels of assessment are encouraged, namely (a) the recollection of facts, principles and theories; (b) the ability to solve problems and describe procedures; (c) demonstration of skill in a controlled setting; and (d) real practice. These four levels are alternatively referred to as knows, knows how, shows how and does (Andrews and Burruss, 2004, p. 14). The four levels provide a framework for resident learning and assessment. The overt act of assessment or measuring brings about greater awareness. And therefore improves learning. In this regard Andrews and Burruss (2004) further point out that the American Council for Graduate Medical Education in September 1997 shifted the focus from assessing the potential of programmes to measuring the actual success.

Andrews, L.B. & Burruss, J.W.B. 2004. Core competencies for psychiatric education, defining, teaching and assessing resident competence. Washington, DC: American Psychiatric Publishing.