{"id":40193,"date":"2017-09-22T17:11:15","date_gmt":"2017-09-22T16:11:15","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=40193"},"modified":"2017-09-25T15:22:41","modified_gmt":"2017-09-25T14:22:41","slug":"jeffrey-aronson-when-i-use-a-word-competence","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/09\/22\/jeffrey-aronson-when-i-use-a-word-competence\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Competence"},"content":{"rendered":"<p><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"112\" height=\"151\" srcset=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg 223w, https:\/\/stg-blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg 446w\" sizes=\"auto, (max-width: 112px) 100vw, 112px\" \/><\/a><span style=\"font-weight: 400\">To <\/span><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/09\/15\/jeffrey-aronson-when-i-use-a-word-performance\"><span style=\"font-weight: 400\">recap<\/span><\/a><span style=\"font-weight: 400\">: the triad of knowledge, skills, and performance is, I have suggested, a modern trivium, underpinned by a modern quadrivium\u2014literacy, numeracy, oracy, and computeracy.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In its <\/span><a href=\"http:\/\/www.gmc-uk.org\/guidance\/good_medical_practice\/knowledge_skills_performance.asp\"><span style=\"font-weight: 400\">document<\/span><\/a> <i><span style=\"font-weight: 400\">Working with Doctors; Working for Patients<\/span><\/i><span style=\"font-weight: 400\">, the General Medical Council defines performance extensionally, listing seven types of activities that it expects doctors to fulfil. Six are prefaced by \u201cYou must\u201d and one by \u201cYou should\u201d, defined as follows:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">&#8220;You must&#8221; is used for an overriding duty or principle.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">&#8220;You should&#8221; [prefaces] an explanation of how you will meet the overriding duty.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">&#8220;You should&#8221; is also used where the duty or principle will not [always] apply, or where . . . factors outside your control . . . \u00a0affect whether or how you can follow the guidance.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">The first point in the <\/span><a href=\"http:\/\/www.gmc-uk.org\/guidance\/good_medical_practice\/maintain_performance.asp\"><span style=\"font-weight: 400\">list<\/span><\/a><span style=\"font-weight: 400\"> includes the requirement that I \u201cmust\u201d be competent as a manager and a researcher, activities that I would have thought should have been qualified with \u201cmay\u201d, i.e. if appropriate. Otherwise, the list seems to me to be unexceptionable, even an instance of <\/span><a href=\"https:\/\/www.cut-the-knot.org\/selfreference\/index.shtml\"><span style=\"font-weight: 400\">self-reference<\/span><\/a><span style=\"font-weight: 400\"> in the sixth point, which says, in effect, that it is the GMC\u2019s guidance that you must follow its guidance, bringing to mind a self-referential drawing by M C Escher (picture).<\/span><\/p>\n<figure id=\"attachment_40195\" aria-describedby=\"caption-attachment-40195\" style=\"width: 606px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-40195\" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache1.jpg\" alt=\"\" width=\"606\" height=\"524\" srcset=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache1.jpg 325w, https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache1-300x259.jpg 300w\" sizes=\"auto, (max-width: 606px) 100vw, 606px\" \/><\/a><figcaption id=\"caption-attachment-40195\" class=\"wp-caption-text\">\u201cDrawing hands\u201d by Maurits Escher (lithograph, 1948)<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400\">The relevant definition of \u201cperformance\u201d in the <\/span><i><span style=\"font-weight: 400\">OED<\/span><\/i><span style=\"font-weight: 400\"> is \u201cThe quality of execution of . . . \u00a0an action, operation, or process; the competence or effectiveness of a person or thing in performing an action; spec. the capabilities, productivity, or success of a machine, product, or person when measured against a standard.\u201d So, in this sense, \u201cperformance\u201d is equivalent to \u201ccompetence . . . \u00a0measured against a standard\u201d, although it is not clear in medicine what that standard is or <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11328518\"><span style=\"font-weight: 400\">might be<\/span><\/a><span style=\"font-weight: 400\">. The <\/span><i><span style=\"font-weight: 400\">OED<\/span><\/i><span style=\"font-weight: 400\"> defines competence as \u201cSufficiency of qualification; capacity to deal adequately with a subject\u201d. How much is sufficient is open to conjecture.<\/span><\/p>\n<figure id=\"attachment_40205\" aria-describedby=\"caption-attachment-40205\" style=\"width: 227px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_competence.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-40205\" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_competence.png\" alt=\"\" width=\"227\" height=\"362\" srcset=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_competence.png 276w, https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_competence-188x300.png 188w\" sizes=\"auto, (max-width: 227px) 100vw, 227px\" \/><\/a><figcaption id=\"caption-attachment-40205\" class=\"wp-caption-text\">\u201cMercury and Paris\u201d by Donato Creti (1745)<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400\">The IndoEuropean root PET meant to rush, leap, fall, or fly. \u201cFeather\u201d is a derivative, via Old Germanic. The god Hermes (Mercury) wore a winged hat, a petasus (<\/span><span style=\"font-weight: 400\">Greek <\/span><span style=\"font-weight: 400\">\u03c0\u03ad\u03c4\u03b1\u03c3\u03bf\u03c2<\/span><i><span style=\"font-weight: 400\">; <\/span><\/i><span style=\"font-weight: 400\">picture). <\/span><\/p>\n<p><span style=\"font-weight: 400\">The Greek word for a feather was \u03c0\u03c4\u03b5\u03c1\u03cc\u03bd and a wing \u03c0\u03c4\u03ad\u03c1\u03c5\u03be<\/span><i><span style=\"font-weight: 400\">,<\/span><\/i><span style=\"font-weight: 400\"> as in pterodactyl and archaeopteryx, the flightless apteryx (the kiwi), and many winged creatures, such as the Aphaniptera (fleas), Cheiroptera (bats), Coleoptera (beetles), Dermoptera (lemurs), Dictyoptera (cockroaches and mantises), Ephemeroptera (mayflies), Hymenoptera (ants, bees, wasps), and Lepidoptera (butterflies and moths). Pteridology is the study of feathery ferns (Greek \u03c0\u03c4\u03b5\u03c1\u03af\u03c2). Aminopterin is the anticancer drug 4-aminopteroyl glutamic acid, a dihydrofolate reductase inhibitor and a derivative of pteroic acid, one of the pterins that give colour to <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17669418\"><span style=\"font-weight: 400\">butterfly wings<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Ptosis (Greek \u03c0\u03c4\u1ff6\u03c3\u03b9\u03c2) is when something falls, as in proptosis and <\/span><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/01\/13\/jeffrey-aronson-when-i-use-a-word-apoptosis\"><span style=\"font-weight: 400\">apoptosis<\/span><\/a><span style=\"font-weight: 400\">. An asymptote to a curve (\u1f00\u03c3\u03cd\u03bc\u03c0\u03c4\u03c9\u03c4\u03bf\u03c2, not falling together) meets its final target only at infinity. Greek \u03c0\u03c4\u1ff6\u03bc\u03b1, any misfortune that befalls us, gives us symptoms, which fall together,<\/span> <span style=\"font-weight: 400\">\u03c3\u03c5\u03bc\u03c0\u03af\u03c0\u03c4\u03b5\u03b9\u03bd.<\/span><\/p>\n<p><span style=\"font-weight: 400\">A suffixed form PET-NA gave Latin words pinna, a feather or a fin, like the pinna of the ear, and penna, a bird\u2019s feather. Penne are pieces of feather shaped pasta and a pennon is a small flag, fancifully shaped like a feather. Pens for writing were once made from feathers.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The Latin word \u201cpetere\u201d means to fall upon, attack, aim at, make for, pursue, strive after, sue for, solicit, ask, seek. It also has a rushing sense, as its root implies. Impetigo spreads rapidly. If it has enough impetus, and if its proponents are not too impetuous, a petition may succeed, especially if the time is propitious, which originally meant \u201crushing forward\u201d and therefore \u201ceager\u201d, and so, typically of the gods, \u201cwell-disposed\u201d. <\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cCompetence\u201d comes from competere (\u201ccum\u201d together + \u201cpetere\u201d), to fall or come together, coincide, be convenient, fitting, due, or applicable. To compete in the 16<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> century meant to be suitable or applicable; this now obsolete meaning gives us \u201ccompetence\u201d and the more recent \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC126659\/\"><span style=\"font-weight: 400\">competency<\/span><\/a><span style=\"font-weight: 400\">\u201d. Competitors, originally fellow seekers, still act together, but in rivalry.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Panache, from another form of the same root, was originally a plume of feathers worn on the pinnacle of a helmet, and one who wore such a plume might be considered to possess panache\u2014elan, swagger, or flamboyance. <\/span><a href=\"https:\/\/www.cairn.info\/revue-d-histoire-litteraire-de-la-france-2008-3-page-607.htm\"><span style=\"font-weight: 400\">Panache<\/span><\/a><span style=\"font-weight: 400\"> plays an important part in Edmond Rostand\u2019s play <\/span><i><span style=\"font-weight: 400\">Cyrano de Bergerac<\/span><\/i><span style=\"font-weight: 400\">, in which \u201cpanache\u201d is Cyrano\u2019s dying word.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Perhaps when we perform competently we should also do so with panache.<\/span><\/p>\n<figure id=\"attachment_40197\" aria-describedby=\"caption-attachment-40197\" style=\"width: 606px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache3.png\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-40197 \" src=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache3.png\" alt=\"\" width=\"606\" height=\"434\" srcset=\"https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache3.png 518w, https:\/\/stg-blogs.bmj.com\/bmj\/files\/2017\/09\/aronson_panache3-300x215.png 300w\" sizes=\"auto, (max-width: 606px) 100vw, 606px\" \/><\/a><figcaption id=\"caption-attachment-40197\" class=\"wp-caption-text\">Cyrano woos Roxanne with panache<\/figcaption><\/figure>\n<p><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>To recap: the triad of knowledge, skills, and performance is, I have suggested, a modern trivium, underpinned by a modern quadrivium\u2014literacy, numeracy, oracy, and computeracy. In its document Working with Doctors; Working for Patients, the General Medical Council defines performance extensionally, listing seven types of activities that it expects doctors to fulfil. Six are prefaced [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmj\/2017\/09\/22\/jeffrey-aronson-when-i-use-a-word-competence\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-40193","post","type-post","status-publish","format-standard","hentry","category-jeff-aronsons-words"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/40193","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=40193"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/40193\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=40193"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=40193"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=40193"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}