The Dreyfus model of skills acquisition (Table 1) describes different levels and aspects of practice in the spiral curriculum (Figure 2) from medical school to specialist training.
Table 1. Summary of the Dreyfus model of skills acquisition
Level 1: novice
Level 2: advanced beginner
Level 3: competent
Level 4: proficient
Level 5: expert
Source: Eraut, M. Developing Professional Knowledge and Competence (1994)
Understanding the five Dreyfus levels will enable foundation doctors to manage each stage of a patient's journey more effectively. They will steadily increase their expertise from having specific skills to managing the whole patient experience. They will gradually need less supervision.
Such models will also help supervisors and assessors expand what they look for in the foundation doctor's work and therefore make better judgements on their progress. In addition to using the F1 and F2 minimum levels of performance required for sign off to assess the progress of the foundation doctor, a supervisor/assessor might consider/ask:
An alternative more graphic representation illustrates various levels of attainment, which might be achieved during foundation training.
Figure 1. Progression towards increasingly independent practice during the foundation programme (although every procedure or action is under supervision in the foundation programme)
In a spiral curriculum, progressive attainment involves increasing knowledge, skills and attitudes. This is illustrated in figure 2 showing the developmental stages involved in order to obtain consent for any procedure.
Figure 2. Example of the spiral curriculum
Based on: Harden RM, Davis MH and Crosby JR Medical Education; 31, 264. (1997)
It is evident, that increasing expertise correlates with more independent practice. An understanding of this progression will help foundation doctors and their trainers to (self-) assess and feedback/reflect more accurately upon clinical management.