The Competency-based Approach - A Lever for Changing Public Health Practices in Québec

When Québec's 2003–2012 National Public Health Program (Programme national de santé publique or PNSP) was updated in 2008, a report highlighted the growing complexity of public health action, particularly when the challenges of integrating the practice of public health in the care and services system at the local level were taken into account. Among the factors challenging the competencies of the actors in the field are the exercise of population-based responsibility arising from amendments to the Act Respecting Health Services and Social Services in 2003, the deployment of the PNSP at all levels of intervention, and the importance of engaging all actors to promote prevention and take action on the determinants of health.

The report highlighted significant limitations in this regard including the fragmentation of knowledge and practices, provision of variable and uncoordinated training, management methods often unsuitable for promoting networking, under-utilization of recognized innovative approaches and related technologies, etc. In short, there was no systemic vision to guide and oversee the development of competencies needed to change practices to achieve system objectives. These findings prompted the Direction générale de la santé publique (DGSP) of the Ministère de la Santé et des Services sociaux (MSSS) to engage in a planning process in order to establish broad competency development policies and strategies worth promoting, including tagging the national training offer in an integrated and coordinated programming.

In this context, in addition to the work performed at MSSS, the Institut national de santé publique du Québec (INSPQ) was given a dual mandate. The first part was to identify and review the approaches to continuous training that were the most innovative and best adapted to the new realities of public health action. The second part was to propose a frame of reference for developing competency profiles to support the implementation of the PNSP.

Designed to support action, this document contains two sections, each of which refers to both parts of the mandate. There is also additional information that provides examples of competency frameworks developed in various public health practice environments.

Section I begins by examining behaviourism, cognitivism, constructivism and social constructivism as major learning theories that have shaped the world of education and training, while a second part presents arguments in favour of a paradigm shift. It highlights some limitations of the objectives-based approach (knowledge fragmentation and division of structures) and explains why it is appropriate to move towards more innovative training practices and more flexible structures. Finally, the last part provides an overview of the competency-based approach and related key concepts.

Section II proposes a frame of reference for developing a competency framework. This frame is derived from Tardif's definition of competencies (2006). The section is rounded out by a more detailed presentation of the e-learning tools and learning strategies introduced with the learning theories in Section I.

The appendix to this document provides an overview of some public health competency frameworks—primarily those developed in North America, Australia and some European countries—for the purposes of reference or further reflection. This survey also includes various frameworks developed by the Québec public health system.

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