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Issues in implementing a real competency-based training and assessment system.

"First, do no harm" is a medical admonition; but harm does occur. There is thus mounting pressure for Medicine to adopt more rigorous systems to ensure professional competency. Traditionally, medical education and professional development has focussed on developing clinical expertise and technical skills within each speciality. Recent studies into the causes of adverse events have highlighted that the failure of non-technical aspects of competency are more common than the failure of technical skills amongst health professionals. Traditional training has also focussed on the individual and yet error management strategies in organisations that require high reliability processes for maintaining safe practice puts the emphasis on the team. It is our contention that the delivery of safe patient care requires a redefinition of professional competency--in terms of the interface between members of the team, patients and the organisational and social requirements of the health system. A change to competency-based training and assessment will require a team-orientated definition of professional competency that may challenge individual professionals and the sovereignty of medical specialities.