There is a specific failure pattern in competency programs that is nearly universal and rarely examined: the annual skills fair where staff rotate through stations, sign a sheet, and are recorded as competent for another year.
What that record actually establishes
That the person attended. Possibly that they performed a skill once, under observation, in ideal conditions, on a manikin, with no time pressure. For a low-risk task that may be sufficient. For a high-risk, low-frequency procedure it establishes almost nothing about whether they could perform it correctly at 3 a.m. on a deteriorating patient.
Three questions worth asking about every validation on your list
- Why is this item on the list? If the answer is “it has always been there”, it may be consuming time that a genuinely high-risk item needs.
- Does the method match the risk? Return demonstration for psychomotor skills; case-based review where clinical judgment is the actual variable; direct observation in practice where the environment matters.
- Who validated the validator? Inter-rater reliability among your validators is almost never checked, and it is usually poor.
Shortening the list is the improvement
The strongest competency programs we see validate fewer items more seriously. That is a harder conversation with leadership than adding items, because a shorter list looks like less rigor until you explain what the long one was buying.