Many health professions education programs in high-income countries (HICs) have adopted a competency-based approach to learning. Although global health programs have followed this trend, defining and assessing competencies has proven problematic, particularly in resource-constrained settings of low- and middle-income countries (LMICs) where HIC students and trainees perform elective work. In part, this is due to programs failing to take sufficient account of local learning, cultural, and health contexts.A major divide between HIC and LMIC settings is that the learning contexts of HICs are predominantly individualist, whereas those of LMICs are generally collectivist. Individualist cultures view learning as something that the individual acquires independent of context and can possess; collectivist cultures view learning as arising dynamically from specific contexts through group participation.To bridge the individualist-collectivist learning divide, the author proposes that competencies be classified as either acquired or participatory. Acquired competencies can be transferred across contexts and assessed using traditional psychometric approaches; participatory competencies are linked to contexts and require alternative assessment approaches. The author proposes assessing participatory competencies through the approach of self-directed assessment seeking, which includes multiple members of the health care team as assessors.The proposed classification of competencies as acquired or participatory may apply across health professions. The author suggests advancing participatory competencies through mental models of sharing. In global health education, the author recommends developing three new competency domains rooted in participatory learning, collectivism, and sharing: resourceful learning; transprofessionalism and transformative learning; and social justice and health equity.

译文

高收入国家的许多卫生专业教育计划 (hic) 采用了基于能力的学习方法。尽管全球卫生计划遵循了这一趋势,但定义和评估能力已被证明是有问题的,特别是在资源有限的中低收入国家 (lmic) 的环境中,HIC学生和受训人员从事选修工作。在某种程度上,这是由于计划未能充分考虑本地学习,文化和健康环境。HIC和LMIC设置之间的主要区别是,HIC的学习环境主要是个人主义的,而LMIC的学习环境通常是集体主义的。个人主义文化将学习视为个人独立于上下文并可以拥有的东西; 集体主义文化将学习视为通过群体参与从特定环境中动态产生的。为了弥合个人主义-集体主义的学习鸿沟,作者提出将能力分为获得性或参与性。获得的能力可以跨背景转移,并使用传统的心理计量学方法进行评估; 参与能力与背景相关联,需要替代评估方法。作者建议通过自我指导的评估方法来评估参与能力,该方法包括医疗保健团队的多名成员作为评估者。提议的将能力分类为获得或参与能力可适用于卫生专业。作者建议通过共享的心理模型来提高参与能力。在全球健康教育中,作者建议开发三个植根于参与式学习,集体主义和共享的新能力领域: 足智多谋的学习; 超专业和变革性学习; 以及社会正义和健康公平。

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