XML-oriented Competency Definition: Systems Approach
Vladimir Goodkovsky, PhD
University of Virginia
vladimir@virgina.edu
Introduction
Study of existing materials about Competency demonstrates diversity of different views
and lack of a single order or system. That is what we are trying to address and hopefully
to compensate in this paper: bring the order into the chaos and propose a system for
Competency Definition.
We feel that systems approach is the best for this purpose.
Systems Principles we used
Principles
Consider any object at least on 3 levels:
super-system, system and sub-systems.
Differentiate external behavior and internal
functioning of the system
Split a complex system into simpler subsystems, select one of interest and replace
others with their actions on selected subsystem and its reactions.
Recommendations
Consider Competence on 5 levels:
Patient Model
Doctors Model
Learner Model
Instructor Model
Medical Education Model
Consider Competence as an internal factor
of a doctor/learner, which defines his/her
external behavior.
Consider Competence with its connection
to tasks to perform and expected
performance.
Super-System: (Medical) Education
In (Medical) Education there are the following needs:
 To define learning objectives based upon professional competencies;
 To collect/design assessments for assessing achievement of the objectives by learners;
 To collect/design learning activities for achieving desired learning objectives;
 To evaluate cross consistency and sufficiency, reveal and fill insufficiencies.
 To sequence available learning activities and assessments for each particular learner
to fill the gaps in objectives achievements by the most effective way.
To meet these educational needs it is necessary:
 To understand professional competencies
 To represent learning objectives based upon professional competencies;
 To understand relations between available assessments and learning objectives they
cover;

To understand relations between available learning activities and learning objectives
they help to achieve.
Medical Educational super-system includes at least 4 systems:
1. Patient
2. Doctor
3. Learner
4. Instructor
Below we propose a unified framework for each subsystem, which is necessary for
overall definition of Competency from different perspectives.
All about competency is presented below in BLUE color.
1. Patient Model in Medical Domain. (Related to VPWG, CWG)
Declarative Representation of a (passive) Patient
External (stimulus-effect, action-reaction) Representation
Stimuli: (exam, test, lab, treatment, drug,…) (controllable mostly)
Stimulus1:
Stimulus ID
Stimulus Description
Expected Effects/Symptoms/Findings (measurable)
Positive Effects/Symptoms/Findings:
Effect/Symptom/Findings 1,
…
Negative Effects/Symptoms/Findings: (optional)
Effect/Symptom/Finding 1,
…
Sub-Stimuli (optional)
…
Stimuli Interrelations
Internal (health) Representation
Int.Systems:
Int.System1:
Int.System ID
Int.System description
Int.System States: (not measurable, yet assessable)
Normal States:
State 1
…
Pathological States:
State 1
…
Sub-Int.Systems (optional)
…
Int.Systems Interrelations
Preferences, Allergies, …
“External X Internal” Relations:
“Stimuli X Int.SystemStates” Relation:
“Stimulus1 X Int.SystemStates” Relation
(describes coverage of Int.SystemStates by Stimulus1)
“Stimulus1 positive effect X Int.SystemStates”
(identifies some normal Int.SystemStates justified
by positive effect of Stimulus1)
“Stimulus1 negative effect X Int.SystemStates”
(identifies some pathological Int.SystemStates
blamed by negative effect of Stimulus1)
“Stimuli X Int.SystemState1” Relation
(identifies some Stimuli, which cover Int.SystemState1)
“Stimuli X Preferences/Allergies” Relation
(identifies some Stimuli, which are acceptable by the patient)
Procedural Representation of a (passive) Patient:
Involuntary changes a current state of his/her Int.Systems
Accepts Stimuli (exam, test, labs, treatments, operations, drugs,…)
Produces Effects (results, symptoms, finding,…)
This Model represents a simple (yet extensible in width and depth) root framework for
specifying an essential part of Medical Competencies (Knowledge of a Patient) at any
level of detail.
2. Doctor Model in Medical Domain (Related to PPWG, CWG)
Declarative Representation of a Doctor Activity
External (stimulus-effect) Representation
Tasks: (controllable somehow)
Task1:
Task ID
What is desired?
Desired Situation in Medical domain of activity
(e.g. desired state of patient’s Int.Systems)
What is available?
Current Situation in (Medical) domain of activity
(e.g. Patient’s raw Data, recognized symptoms)
Resources to use:
Reference Materials
Time
Tools
Labs
Other Doctors
What is expected performance? (measurable somehow)
Standard performances:
Standard Performance 1,
…
Typical Fault performances: (optional)
Fault 1
…
Sub-Tasks (optional)
…
Tasks Interrelations
Internal (mental resource) Representation
D.Competencies: (includes the Patient Model)
D.Competence1: (a specific part of the Patient Model)
Identifier
Type:
Ability
Knowledge
Skill
Attitude
Undefined
Description
State = Achieved (not measurable, yet assessable)
Sub-D.Competencies (optional)
…
D.Competencies Interrelations
Preferences
“External X Internal” Relations:
“Tasks X D.Competencies” Relation
“Task1 X D.Competencies” Relation
(describes coverage of some D.Competencies by Task1)
“Task1 standard performance X D.Competencies
(identifies some D.Competencies justified by
standard performance of Task1)
“Task1 fault performance X D.Competencies
(identifies some D.Competencies blamed by fault
performance of Task1)
“Tasks X D.Competence1” Relation
(identifies some tasks, which activate D.Competence1)
“Tasks X Preferences” Relation
Procedural Representation of a Doctor Activity
Prepares for the Service
Reeds History of Present Illness, recognizes symptoms, findings
Reeds Past Medical History, recognizes symptoms, findings
Reeds Social History, recognizes symptoms, findings
Reeds Family History, recognizes symptoms, findings
Provides the Service
Reviews Int.Systems, recognizes symptoms, findings
Performs Physical Examination, recognizes symptoms, findings
Assigns Labs and reeds results, recognizes symptoms, findings
Assigns Radiology and reeds results, recognizes symptoms, findings
Assigns Procedures
Makes diagnosing decision
Plans Therapy
Follows up
3. Learner Model in Educational Domain. (Related to MWG, PCLWG, CWG)
Declarative Representation of a Learner Activity
External (stimulus-effect) Representation
Tasks: (controllable somehow)
Task1:
Task ID
What is desired?
Desired Situation in domain of activity
What is available?
Current Situation in domain of activity
Resources to use:
Learning Materials
Self-test items
Time
Tools,
The Virtual Patient
Simulated Patients,
Standardized Pateint,
Other Learners, Doctors, Instructors
What is expected performance? (measurable somehow)
Standard performances:
Standard Performance 1,
…
Typical Fault performances: (optional)
Fault 1
…
Sub-Tasks (optional)
…
Tasks Interrelations
Internal (mental resource) Representation
L.Competencies: ()
(L.Competencies may be defined on the basis of D.Competencies and
include a subjective Patient Model)
L.Competence1: (e.g., a specific part of subjective Patient Model)
Identifier
Type:
Ability
Knowledge
Skill
Attitude
Open
Description
Mastery States: (not measurable, yet assessable somehow)
Ground Zero
Supplied
Achieved
Sub-L.Competencies (optional)
…
L.Competencies Interrelations
Preferences
“External X Internal” Relations:
“Tasks X L.Competencies” Relation
“Task1 X L.Competencies” Relation
(describes coverage of some L.Competencies by Task1)
“Task1 standard performance X L.Competencies
(identifies some L.Competencies justified by
standard performance of Task1)
“Task1 fault performance X L.Competencies
(identifies some L.Competencies blamed by fault
performance of Task1)
“Tasks X L.Competence1” Relation
(identifies some tasks, which activate L.Competence1)
“Tasks X Preferences” Relation
Procedural Representation of a Learner Activity
Learns to prepare for a Service:
Learns to reed History of Present Illness, recognize symptoms, findings
Learns to reed Past Medical History, recognize symptoms, findings
Learns to reed Social History, recognize symptoms, findings
Learns to reed Family History, recognize symptoms, findings
Learns to provide a Service:
Learns to review Int.Systems, recognize symptoms, findings
Learns to perform Physical Examination, recognize symptoms, findings
Learns to assign Labs and reed results, recognize symptoms, findings
Learns to assign Radiology and reed results, recognize symptoms, findings
Learns to assigns Procedures
Learns to make diagnosing decisions
Learns to plan Therapy
Learns to follow up
4. Instructor Model in Educational Domain (Related to LO, PCLWG)
Declarative Representation of a Instructor Activity
External (stimulus-effect) Representation
Tasks: (controllable somehow)
Task1:
Task ID
What is desired?
Learning Objectives = some D.Competencies
What is available?
Current Achievements = L.Competencies
Resources to use:
Learning Materials
Assessments, Test Items
Time
Tools
Patients, Doctors, Learners, Instructors
What is expected performance? (measurable somehow)
Standard performances:
Standard Performance 1,
Sequence of Learning Materials and
test Items
…
Typical Fault performances: (optional)
Fault 1: Wrong Sequence of Learning
Materials and test Items
…
Sub-Tasks (optional)
…
Tasks Interrelations
Internal (mental) Representation
T.Competencies: (not measurable, yet assessable somehow)
T.Competence1:
Identifier
Type:
Ability
Knowledge
Skill
Attitude
Open
Description
State = Achieved
Sub-T.Competencies (optional)
…
T.Competencies Interrelations
Preferences
“External X Internal” Relations:
“Tasks X T.Competencies” Relation
“Task1 X T.Competencies” Relation
(describes coverage of some T.Competencies by Task1)
“Task1 standard performance X T.Competencies
(identifies some T.Competencies justified by
standard performance of Task1)
“Task1 fault performance X T.Competencies
(identifies some T.Competencies blamed by fault
performance of Task1)
“Tasks X T.Competence1” Relation
(identifies some tasks, which activate T.Competence1)
“Tasks X Preferences” Relation
Procedural Representation of a Instructor Activity
Prepares for teaching
Studies his/her learner and builds the learner model
Collects available learning materials
Collects available testing items
Accepts/formulates learning objectives
Defines a learning strategy
Connects all of it together
Checks consistency and sufficiency
Realizes teaching
Selects a mode: presenting or testing
Selects next learning material or test item depending of the mode selected.
Recognizes learner’s performance
Updates learner Model
Checks achievement of learning objectives
Justification:
Provided Models represent a systems context for cross-definition of Competencies.
In such a context, competencies may be defined as
1. something that includes the Patient Model;
2. the internal representation of Doctor’s ability to perform external (medical) tasks.
3. the internal representation of Learner’s ability to perform external (educational)
tasks. This definition can be easily detailed by extending the model. For example,
competencies can be defined as good and not so good. Standard performance of
the tasks can justify good competencies. Fault performances can blame not so
good competencies.
4. Possible base line and learning objectives of the instructor.
Competencies can be decomposed into any number of sub-competencies, each of which
can be decomposed into sub-sub-competencies and so on.
Competencies may have relations. For example: prerequisite relations, analogy, …
But what is the most important for education; the models establish relations required for
performing educational tasks by instructor (human or machine). Particularly:
 It defines learning objectives based upon Competencies;
 It establishes relations between available tasks (such as assessments) and learning
objectives they cover;
 It establishes relations between available tasks (such as learning activities) and
learning objectives they help to achieve.
It means that these models are able to support solution of main educational tasks. They
are extendable in width (you can add new sibling elements) and in depth (you can add
new child elements). The tasks and competencies are also recursively extendable in
depth, which means that you can add sub-tasks to any task and sub-competencies to any
competence. The models are ready for XML notation.
Vocabulary adjustment may be required.