Benner's Stages of Clinical Competence Mike Dale In 1984 Benner, in an effort to clarify the processes that students go through,

in this case nurses, applied the Dreyfus Model of Skill Acquisition to the learning process. However the model, theory, can be applied to any practice or profession, regardless of discipline. The acquisition and development of a skill, according to the Dreyfus model, involves a staged process whereby the student progresses through five overt levels of proficiency. The levels, or stages, are: novice, advanced beginner, competent, proficient, and expert. Each of the levels will reflect the changes that the student has experienced with the regard to knowledge development and situational recognition, in the skill development. These changes can include: 1. a shift from reliance on theoretical or abstract principles to past concrete experiences. In other words what worked previously should work again. 2. a change in the learner's perception of situations. According to Benner this means that a situation is no longer seen as a collection of equally relevant bits, but more as a complete whole in which only certain parts are relevant. 3. a move from being a detached observer to being and involved performer. The five stages are: Novice Novices, as would be expected, have no experience of the situations in which they are expected to perform (Benner 1984). In order to overcome this they rely on the rules they have been taught which, because they tend to be contextfree and independent of specific cases, they are often applied universally (Eraut 1994). Because of this novices are often perceived as being inflexible, and their behaviour limited, not least because they have no "life experience" in the application of rules (Benner 1984). Advanced Beginner Advanced beginners are those who have experienced some real situations from which they have drawn some recognition or understanding, and are able to demonstrate a degree of acceptable performance (Benner 1984). From this the advanced beginner has begun to formulate guides to direct their actions. Therefore these principles are based on experience (Eraut 1994). Competent According to Benner (1984) competence is typified by the practitioner who has carried out their role in the same or similar situations over two or three years. During this time they develop their actions in terms of long-range goals or plans of which they are consciously aware (Benner 1984), she goes on to suggest that competent practitioners will formulate plans, based on a Mike Dale 2009 Page 1

conscious, abstract, and analytic consideration of the problem, from which they can establish a perspective on the situation. For example they may recognise that aspects of the environment are leading to particular problems, and therefore by changing or altering the features the number of incidents should be reduced. Alternatively they may recognise patterns in behaviour that could lead to further health problems if not checked i.e. poor dietary habits. Conscious decisions that led to deliberate planning will help achieve efficiency and organization (Benner 1984). However the competent practitioner has yet to develop the speed and flexibility inherent within the proficient level, but they will experience feelings of mastery over situations (Eraut 1994). Proficient At the proficient level the practitioner is able to recognise situations as a whole, and are able to identify the most salient, and important aspects (Eraut 1994). This is possible because the situation is read in relation to the long term goals. Benner (1984) suggests that when operating at the proficient level practitioners have learned from experience, and are able to predict, what events are likely to occur in a given situation, and can plan changes in response to these events. The proficient practitioner will recognise when the expected normal picture does not materialize. Holistic understanding improves decision making, as it will be less labour intensive because the practitioner will understand which of the aspects are the important ones (Benner 1984). The Expert An expert has no need to rely on an analytic principle i.e. a rule, or guideline, to establish connections between an understanding of the situation and the appropriate action (Eraut 1994). Further Benner (1984) states that the expert has a wide range of experiences on which to draw, and will be able to intuitively grasp the problem and the most likely causes and solutions without the need to go through wasteful consideration. In this way she points out they appear to be unaware of the rigidity of the rules, and will act in a way that is flexible with behaviour that matches the situation. But such spontaneity does not precluded analysis, on the contrary this is a tool that will be used in novel situations where the best solution must be identified, similarly it will also come into play when a situation has perhaps been misunderstood and things do not unfold as predicted or expected (Benner 1984). References Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley. Eraut, M. (1994) Developing Professional Knowledge and Competence. The Falmer Press

Mike Dale 2009

Page 2