Contents lists available at ScienceDirect Research in Social and Administrative Pharmacy journal homepage: www.elsevier.com/locate/rsap The role of disengagement in the psychology of competence drift Zubin Austin * , Paul A.M. Gregory Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada ARTICLE INFO Keywords: Competence Disengagement Competence drift Maintenance of competence ABSTRACT Background: The framing of competence as a binary “either-or” process may be shaped by the measurement tools and assessment methods used to define it. Blunt measures such as passing or failing a licensure examination, or revoking/suspending a license after a single dispensing error fosters anxiety amongst professionals and poten- tially leads to behaviours where learning needs are actually hidden from educators, employers or regulators. Such framing may not accurately capture the lived experience of those labelled “incompetent” and in fact may be counterproductive to remediation and skills enhancement. Objectives: To examine the construct of competence as a lived experience amongst pharmacists who had been identified and labelled as incompetent by their regulatory body. Methods: A multiple single-case research design (described by Kratochwill and Levin) involving 14 practicing pharmacists identified as not meeting competence standards by their regulatory body in Ontario, Canada was used for this research. Constant-comparative qualitative analysis of semi-structured interview data was coded, categorized and used to identify and describe major research themes. Results: Two major themes were identified, related to the personal and professional consequences of being la- belled “incompetent” by one's regulatory body, and the importance of psychological engagement in one's own profession in facilitating maintenance of competence. Conclusions: This study highlighted the importance of disengagement as both a cause and consequence of competence drift and pointed to the impact of regulatory policies, practices, and assessment systems that may actually inadvertently contribute to this disengagement. 1. Background Maintenance of competence is a significant issue for regulators, educators, practitioners and – most importantly – patients. The term “competence” itself is contestable, and no single agreed upon definition of it exits. 1 Generally, competence is thought to relate to fitness or ability to practice, and to remain up-to-date with developments in the profession. 2 Increasingly, competence has been conceptualized around standards or practice, expectations, or statements related to the specific tasks or activities of a profession, though this has been criticized as being reductionist in orientation, and incapable of actually capturing the ethical and interpersonal complexity of professional work. 3 Me- chanisms by which clinicians remain current in their field and are able to continue to provide safe and effective care to patients in the years and decades following graduation and initial qualification in their field have been the source of debate and discussion. 1–3 Historically, reg- ulators have focused on development of assessment tools and ap- proaches designed to detect/identify individuals who were no longer competent, and who thus theoretically posed a greater potential risk to the patients they serve. 4,5 Framing competence in this binary manner (competent vs incompetent) was aligned with a model of professional practice that defined competence itself in terms of observable, mea- surable behaviour. Hodges and Lingard, quoting Burke, have noted that “every way of seeing is also a way of not seeing” 6 : our view of competence as a binary state is conveniently with the use of assessment tools (such as multiple choice tests and objective structured clinical examinations) that pro- duce binary pass-fail decision points. As a result, within the cultures of regulation, education, and practice, the dominant paradigm of com- petence has emerged within which all professions function today: an individual is either competent or s/he is not. As a result of this binary notion of competence, there are only limited ways in which individuals can be identified as not being competent: failure to pass a board/li- censing examination at initial licensure, or actions taken by a regulator to limit/remove registration due to errors or ethical concerns that may in fact be multifactorial in nature. The lived experience of practitioners, however, suggests such a binary, dialectical model of competence is not only unrelated to day-to- https://doi.org/10.1016/j.sapharm.2018.02.011 * Corresponding author. E-mail address: zubin.austin@utoronto.ca (Z. Austin). Research in Social and Administrative Pharmacy xxx (xxxx) xxx–xxx 1551-7411/ © 2018 Published by Elsevier Inc. Please cite this article as: Austin, Z., Research in Social and Administrative Pharmacy (2018), https://doi.org/10.1016/j.sapharm.2018.02.011