• Dorothy Breen, George Shorten, Annette Aboulafia, Dajie Zhang, Cord Hockemeyer, and Dietrich Albert.
• Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland.
• Clin Teach. 2014 Dec 1; 11 (7): 531-6.

BackgroundIn recent years there has been a move towards a competency-based model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identified. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other.MethodsIn the first part of the study an extensive hierarchical task analysis (HTA) was undertaken to determine the competencies necessary for the performance of spinal anaesthesia. Secondly, the concept of competency-based knowledge space theory (CbKST) was applied to the map. CbKST is based on the principle that acquisition of a specific skill is usually preceded by a number of dependent or prerequisite skills. Our aim was to map the individual competencies necessary to perform a given procedural skillResultsThe analysis yielded a comprehensive HTA of the skills necessary to perform spinal anaesthesia, comprising 509 individual competencies. Applying the concept of CbKST yielded 194 key competences with at least one dependent or prerequisite skill.DiscussionWe have defined a comprehensive HTA or competency map for use in the assessment of the performance of spinal anaesthesia. This CbKST approach will provide clinicians who undertake medical procedures to better understand their own performance, and to improve over time.© 2014 John Wiley & Sons Ltd.

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