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Context:   Current debate in medical education focuses on the nature of 'competency-based medical education' (CBME) and whether or not it should be adopted. Many medical schools claim to run 'competency-based' curricula, but the structure of their programmes can differ radically. A review of the existing CBME literature reveals that little attention has been paid to defining the concept of competence. A straightforward examination of what is meant by the term 'competence' is noticeably missing from the literature, despite its impact on medical training., Objectives:   This paper aims to illustrate the varying conceptions of 'competence' by comparing and contrasting definitions provided in the health sciences education literature and discussing their respective impacts on medical education., Methods:   A systematic review of recent publications in medical education journals published in English and French was conducted to extract definitions of competence or, if definitions were not explicitly stated, to derive the authors' implicit conception of competence. A sample of 14 definitions from articles in the health sciences education field was studied using thematic analysis., Results:   There is agreement that competence is composed of knowledge, skills and other components. Although agreement about the nature of these other components is lacking, attitudes and values are suggested to be essential ingredients of competence. Furthermore, a clear divergence in conceptions of how a competent person utilises these components is apparent. One view specifies that competence involves selecting components according to specific situations, as required. A second view places greater emphasis on the synergy that results from the use of a combination of components in a given situation., Conclusions:   These conceptual distinctions have many implications for the way CBME is implemented. A conception of competence as the selection of components may lead to a greater emphasis, in a training setting, on the mastery of each component separately. A conception of competence as the use of a combination of components leads to greater emphasis on the synergy that results as they are deployed in clinical situations., (© Blackwell Publishing Ltd 2012.)

Objectives: The ability to innovate new solutions in response to daily workplace challenges is an important component of adaptive expertise. Exploring how to optimally develop this skill is therefore of paramount importance to education researchers. This is certainly no less true in health care, where optimal patient care is contingent on the continuous efforts of doctors and other health care workers to provide the best care to their patients through the development and incorporation of new knowledge. Medical education programmes must therefore foster the skills and attitudes necessary to engage future doctors in the systematic development of innovative problem solving. The aim of this paper is to describe the perceptions and experiences of medical students in their third and fourth years of training, and to explore their understanding of their development as adaptive experts., Methods: A sample of 25 medical students participated in individual 45-60-minute semi-structured interviews. Interviews were audiotaped, transcribed and entered into NVivo qualitative data analysis software to facilitate a thematic analysis. The analysis was both inductive, in that themes were generated from the data, and deductive, in that our data were meaningful when interpreted in the context of theories of adaptive expertise., Results: Participants expressed a general belief that, as learners in the health care system, exerting any effort to be innovative was beyond the scope of their responsibilities. Generally, students suggested that innovative practice was the prerogative of experts and an outcome of expert development centred on the acquisition of knowledge and experience., Conclusions: Students' perceptions of themselves as having no responsibility to be innovative in their learning process have implications for their learning trajectories as adaptive experts.