How Understanding the Four Stages of Competence Can Improve the Way You Learn and Teach

In 2004, I started the University of Arizona’s Paramedic program. It was an intense program by any standard – sixty-four credit hours and hundreds of clinical hours in the space of nine months.

Despite a history of being a good student for whom academics came easily – or maybe because of it – I really struggled with feeling out of my depth. The added pressure of knowing that a mistake could seriously harm or even kill someone weighed heavily on me. I was tired, I was stressed, and mostly I spent a lot of time feeling frustrated that things just weren’t clicking for me.

As I made my way through the program, I got one lesson that sticks out to me all these years later – and it didn’t have anything to do with medicine. It was about how we learn, and it really altered my perspective and helped me dig in and keep going.

There are four stages of competence: unconscious incompetence, conscious incompetence, conscious competence, and unconscious competence. As you learn a new skill, you progress through the four stages, sometimes moving back and forth between each. Competence is not necessarily a straight line, it’s more like a ladder – and sometimes you have to go back down a rung to get your footing.

Unconscious incompetence means that you don’t know what you don’t know, or even that you need to know it. It can be easy to set expectations too high in this stage. Conscious incompetence is the most frustrating stage of all – you know what you don’t know, and it’s often at this point that people become overwhelmed. Conscious competence is when things start to click – you know what you need to know and how to achieve it, you just have to think about it. Unconscious competence is that stage where you can finally complete a task easily.

In an ideal world, one would move right from one stage to another, but it’s not always that simple. Learning to be a good paramedic (or any kind of clinician) is a lot like peeling an onion. You think you’ve gotten there, only to find that there’s another, deeper layer. For me, understanding that the emotions I was feeling were normal and that things would start to click eventually really helped me keep going when I felt like I was drowning. I graduated from the program and did well – I passed the certification exam on my first try and had a successful career in EMS.

Over the years I’ve come back to the four stages of competence time and time again. When I’m facing a difficult project with a steep learning curve, I can manage my expectations and frustrations more effectively. As I transitioned out of a clinical role and started spending more time training, understanding this process made me a more empathetic – and therefore more effective – trainer.

HybridChart was created developed by a practicing physician, for physicians. Learn more about our story and the people behind HybridChart.

Kisha Crofts Author
Kisha Crofts is the Director of Product Management and Implementation at HybridChart. She has worked in medicine for over fifteen years, including roles in EMS, Cardiology, and clinical application management. She lives in Goodyear, Arizona with her family.
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