Accepted Version R1

University of Southern Denmark
What do we mean by “transferable skills”? A literature review of how the concept is

conceptualized in undergraduate health sciences education
Olesen, Kristoffer Brix; Christensen, Mette Krogh; O'Neill, Lotte Dyhrberg
Published in:
Higher Education, Skills and Work-Based Learning
DOI:
10.1108/HESWBL-01-2020-0012
Publication date:
2021
Document version:
Accepted manuscript
Citation for pulished version (APA):

Olesen, K. B., Christensen, M. K., & O'Neill, L. D. (2021). What do we mean by “transferable skills”? A literature
review of how the concept is conceptualized in undergraduate health sciences education. Higher Education,
Skills and Work-Based Learning, 11(3), 616-634. https://doi.org/10.1108/HESWBL-01-2020-0012
Go to publication entry in University of Southern Denmark's Research Portal
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Download date: 16. Oct. 2023

Hi
Higher Education, Skills and Work-Based Learning
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Edu
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WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A

LITERATURE REVIEW OF HOW THE CONCEPT IS
ills
CONCEPTUALIZED IN UNDERGRADUATE HEALTH SCIENCES

EDUCATION
an
Journal: Higher Education, Skills and Work-Based Learning
Manuscript ID HESWBL-01-2020-0012.R1
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Manuscript Type: Literature Review
health science education, higher education, literature review, transfer,

Keywords:
generic skills, Employability
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Page 1 of 79 Higher Education, Skills and Work-Based Learning
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4 Manuscript ID HESWBL-01-2020-0012
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"WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A LITERATURE REVIEW OF HOW THE CONCEPT IS CONCEPTUALIZED IN
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7 HEALTH SCIENCES EDUCATION"
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9 Submitted to Higher Education, Skills and Work-Based Learning.
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Response to review
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16 Dear Editor, dear reviewers,

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18 We are grateful for the comments and insightful suggestions from the two reviewers and the editor.
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20 Your careful reading and feedback have given us the opportunity to engage in an educative process
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in the rewriting the paper, and we really appreciate the many encouraging and challenging
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23 comments. We have done our best to improve the paper according to the suggestions, and we hope
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25 the following response to the reviewer’s comments meet the expectations and standards for a paper
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to be published in Higher Education, Skills and Work-Based Learning. If you have any questions or
28 further comments, please do not hesitate to contact us again and we will be happy to respond.
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33 Reviewer 1 Response
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36 1. Originality: In order to avoid any confusion or
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38 misunderstanding of our review, the word
On balance this paper seems to be offer
39 “systematic” is deleted in the abstract, the
40 important insights into an area of ambiguity-
41 introduction and the method section.
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the lack of clarity re the concept of transferable
43 skills. There are however for me a few areas The mixed studies literature review is the
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45 which require revision; The abstract claims the correct term to use in this study, since we
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47 paper is a systematic review but then also uses apply the type of literature review described
48 the term mixed studies literature review. Surely by Pluye and Hong (2014).
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50 a literature review by its very nature has a

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52 mixture of studies, grey literature etc so I would
53 suggest consistency re the use of terms.
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56 Grammatically, the abstract is very 'wordy' and The whole paper has now been proof read.
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58 in need of a proof read. See the attached certificate from VidKom.
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Higher Education, Skills and Work-Based Learning Page 2 of 79
Hi
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4 I am a bit confused re the use of the term Thank you for reminding us of our blind spots.
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health sciences education, which seems to be We (the authors) come from an academic
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7 used a a bit of a catch all and then is not tradition where health sciences education is
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9 elaborated upon, clarified or justified the broader term for a large variety of
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sufficiently in the introduction- this is a theme I healthcare, health professional and health
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will return to throughout my comments. science education programs. Thus, we were
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14 not aware that this term could be
What is health sciences education, is this the
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16 misunderstood. In order to clarify what we

correct term to use and why health sciences?
17 mean by health sciences education (HSE), we
18 Do you need to clarify this is UG education
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19 have added an explanation in the introduction

20 only? - I think I only realised this at the
21 (see page 9, yellow text). The explanation is
22 conclusion?
inspired by one of the most estimated journals
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24 within the field of health sciences education:
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26 Advances in Health Sciences Education.

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28 In addition, we have added a sentence in the
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results section (page 9, before “Emerging
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31 Themes”, see yellow text) about the
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33 dominance of healthcare and health

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professionals’ education, especially medicine
36 and nursing.
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39 2. Relationship to Literature: The section “Purpose of the Present Study” is
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41 now improved and includes further
I believe this is a valuable study which currently
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42 explanation of the purpose and the relevance

43 is hampered by a number of the comments I
44 of the study to healthcare workforce (see
have mentioned above.
45
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46 page 5, yellow text).

47 In the section on the purpose of the study there
48 is scant mention to the health workforce - this
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50 requires clarification. I think this could be

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52 solved by focusing on the healthcare
53 workforce?
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Hi
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4 Furthermore the majority of the papers See the added sentence in the results section
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included in the review relate to the healthcare (page 9, before “Emerging Themes”, see
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7 workforce, doctors and nurses in particular yellow text) about the relevance of the results
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9 (68%) ? for healthcare and health professionals
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education.
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13 The rationale offered re demographics of an We have added new references to the section
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15 ageing population etc is an old reference and “Purpose of the Present Study” (page 5,
ati
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17 requires further explanation. Here there are age yellow text) but kept the references from The
18 differences by cohort and effects upon both Lancet and New England Journal of Medicine
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20 health and social care. because they are good and highly relevant
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22 articles for this study.
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24 3. Methodology: We have explained the definition of health
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26 sciences education above, in the introduction

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28 (page 2-3, yellow text), in “Purpose of the
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29 I think if the health sciences vs healthcare

Present Study” (page 5, yellow text) and
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science issue is resolved the research question
31 included a sentence in the results section
32 changed the search strategy and
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33 (page 9, before “Emerging Themes”, see

34 implementation appears to be robust.
yellow text), which should align the research
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36 question, the method (in particular the chosen
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38 search terms and the inclusion of studies) and
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the results in a better way.
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42 I think the authors have been too hard on Thank you – we understand you comment as a
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44 themselves in the limitations section. praise. However, we see no reason to change
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this section, as we believe it includes
47 important considerations we have had during
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49 the study.
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52 The presentation of the results were an See the added sentence in the results section
53 interesting read. In relation to the issues (I am (page 9, before “Emerging Themes”, see
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55 sorry to keep coming back to this) I am just yellow text) about the relevance of the results
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finding it difficult to generalise to health for healthcare workers and health
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58 sciences when the majority of the studies are professionals’ education.
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Hi
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3 health care. The implications of the review are
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5 therefore more applicable to this area and no
er
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7 so easily transferred to sports science for
8 example (which is health science, as i
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10 understand it)?
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13 4. Results: Thank you 
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15 The authors have presented and discussed the
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17 results in a thematic manner, and I found this
18 section to be an interesting read.
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21 5. Implications for research, practice and/or In the “introduction”, we have added a
22
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23 society: detailed description of the term health

24 sciences education (see page 2-3, yellow text),
25 The points I have made earlier need to be
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26 and in the “Purpose of the Present Study”

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addressed for any conclusion to be relevant to
28 (page 5, yellow text) we have elaborated on
either healthcare or health sciences education.
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the relevance of the study.
30 As it stands, based on the papers included in
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32 the review, this has more relevance to health
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33 care.
34 Regarding the conclusion, we acknowledge
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Claims are made in the paper re the health this reviewer’s critique and thus merged the
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37 workforce- but no mention of this in the “Perspectives” and “Conclusion” into one
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39 conclusion. main section called “CONCLUSIONS AND
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PERSPECTIVES” (page 18-20, yellow text) in
41 The conclusion is very brief generally?
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42 order to address the relevance of our study to

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44 healthcare professionals.
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6. Quality of Communication: Does the paper The whole paper has now been proof read.
48 clearly express its case, measured against the See the attached certificate from VidKom.
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50 technical language of the field and the expected

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52 knowledge of the journal's readership? Has
53 attention been paid to the clarity of expression
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55 and readability, such as sentence structure,
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jargon use, acronyms, etc.:
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Hi
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gh
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3 The paper needs a robust proofread and edit.
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5 Some sentences are 'clumsy' for eg, the same
er
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7 word in the same sentence?
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9 The opening two sentences of the abstract - I
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found this wordy?
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13 Do the title, keywords, abstract adequately As described in “Purpose of the Present
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15 reflect the paper's content? Readers will locate, Study” (see page 5, line 5) and in the Method
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17 and potentially cite, the article based on these section subtitle “Stage 2: Eligibility Criteria”
18 words - they are crucial: No (line 18-21), our purpose was not to focus on
on
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20 healthcare workers. However, the results of
If you have answered No, please provide
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22 our study turned out to be representative of
feedback below and suggest alternative titles
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23 and concentrated in healthcare and health

24 and keywords if appropriate.: For me its to sort
25 professionals’ education, especially medicine
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out of this is health sciences or health care

26
27 and nursing (see “Results”, page 9 line 10-17,
education?
28 and “Conclusion and Perspectives”, page 18
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30 line 15-23, page 19 line 4, and line ).
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Oh, also make the point this is UG
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Regarding UG: we have added
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36 “undergraduate” to the title.
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39 Do you feel the paper gives adequate OK
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international coverage (if appropriate)? Please
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42 provide details if possible.: I am thinking yes.

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45 Would this paper be of interest to an In the “Purpose of the Present Study” (page 5,
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international audience? Please provide details if yellow text) we have elaborated on the
48 possible: relevance of the study, and by merging the
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50 perspectives and the conclusions we have

Possibly if the authors address the issues of
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52 made a clearer justification of the study.
clarity and justification/ purpose.
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Also, we believe that the proof reading of the
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paper has improved the clarity and readability
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57 of the paper.
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Hi
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4 Reviewer 2 Response
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Do you feel the paper gives adequate We acknowledge that there might by a
8 international coverage (if appropriate)? Please language bias because we conducted the
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10 provide details if possible.: Yes, I think so but literature search in English. We were aware of
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12 this needs to be in context how of the health this problem when we included or excluded
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13 delivery systems and health education studies during the screening proces. However,
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15 programmes as they are delivered differently it was a criterion that the included studies were
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17 globally and the language used in this paper written in English. Therefore, the authors of the
18 may not apply. included studies have themselves translated
on
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20 the educational level into Anglo American
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22 standards. Of course, there may be countries
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23 where there is no precise and comprehensive

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25 Would this paper be of interest to an term that matches the English designations. But
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international audience? Please provide details if since all the studies have been published in a
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28 possible: as above. peer-reviewed journal, there has been a quality
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30 control of the translation.
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We believe that the research theme of this
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36 review is relevant internationally.
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Furthermore, it is relevant to mention that the
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42 Bologna Declaration (1999) sought to bring

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44 more coherence to higher education systems
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across Europe. However, the Declaration was

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47 for most countries first implemented around
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49 2008. Since most of the studies were published

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after 2008, comparing studies from different
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52 European countries has been a relatively simple
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5 This document certifies that the manuscript entitled
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WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A
ills
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9 LITERATURE REVIEW OF HOW THE CONCEPT IS
10 CONCEPTUALIZED IN HEALTH SCIENCES EDUCATION
an
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12 Authored by
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14 Kristoffer Brix Olesen
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16 was edited for proper English language, grammar, punctuation, spelling, and overall style by
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17 one or more of the highly qualified native English speaking editors at VidKom.
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19 This certificate was issued on 10 May 2020 and may be verified by
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20 contacting VidKom at mpi@mpikom.dk.
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Neither the contents of the research nor the intentions of the authors were changed in any way
sed
22 during the editing process. Documents receiving this certification should be English-ready for
23 publication; however, the author has the ability to accept or reject our suggestions and make any
24 changes they wish after having received the proofread and copyedited version.
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28 If you have any questions or concerns about the edited document, please contact VidKom at mpi@mpikom.dk
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Hi
Running head: What Do We Mean By ‘Transferable Skills’? 1
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3 WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A LITERATURE REVIEW OF HOW THE
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6 CONCEPT IS CONCEPTUALIZED IN UNDERGRADUATE HEALTH SCIENCES EDUCATION
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11 ABSTRACT
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13 Purpose: Due to rapid changes in the future labor market, transferable skills are recognized
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16 as a vital learning outcome for students in undergraduate higher education. However,
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18 ambiguities surrounding the concept and content of transferable skills hampers the actual
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teaching and learning of transferable skills. Consequently, there is a great need for an
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23 overview of the literature on transferable skills to qualify and develop our approaches to
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25 transferrable skills in higher education. This study aims to outline a typology of how
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28 transferable skills are conceptualized in health sciences education, that is medicine, nursing
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30 and related health professionals education.
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33 Design: The study was a mixed studies literature review, which included quantitative,
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35 qualitative, and mixed-methods studies. A seven-stage sequential exploratory synthesis of

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the included studies was conducted.
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40 Findings: This review showed that transferable skills reflected three main
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conceptualizations: Program Requirements, Employability, and Holistic Development.
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45 Overall, the global methodological quality of the empirical studies of interventions to
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47 further transferable skills development in health science education was weak.
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50 Practical implications: By distinguishing between three main conceptualizations of
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52 transferable skills, this study’s typology supports alignment in transferable skills curricula
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55 because conceptually sound learning objectives provide teachers and students in health
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57 sciences educations with a clear purpose, and direct educators’ choice of relevant teaching
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and assessment strategies.
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3 Research implications: Last, but not least, this study aids clear conceptualization in future
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6 empirical studies.
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8 Originality: This review – the first of its kind – contributes to conceptualization of
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11 transferable skills as the basis for curriculum development and research.
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16 Keywords: health science education; higher education; literature review; transfer; generic
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18 skills; employability.
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23 INTRODUCTION
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25 Due to rapid changes in the future labor market, transferable skills are widely
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28 recognized as a vital learning outcome for students in higher education (European Union,
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30 2011; European Union, 2016; OECD, 2016; Universities UK, 2018; Succi, & Canovi, 2019).
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33 Transferable skills are assumed an essential prerequisite for developing graduates’
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35 adaptability, flexibility, and employability, affording them the opportunity to rapidly adapt
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to future change (Jones et al., 2010; EU, 2016; Succi, & Canovi, 2019). However, the
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40 conceptual vagueness and ambiguity concerning both the concept and the content of
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transferable skills hamper the actual teaching and learning of transferable skills (Kember et
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45 al., 2007; Green et al., 2009; Jääskelä et al., 2018). The lack of conceptual alignment and the
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47 lack of content specificity also threaten evaluation and empirical investigation of
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50 transferable skills (Strijbos et al., 2015; Chan et al., 2017). Consequently, there is a great
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52 need for a overview of the literature on transferable skills to r support students’

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55 development of such skills. This mixed studies literature review (Pluye and Hong, 2014)
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57 outlines a typology of how transferable skills are conceptualized and empirically

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investigated in the field of health sciences education (HSE), that is the bachelors and/or
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3 masters level of educational programs within healthcare, health profession and health
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6 sciences such as medicine, nursing, occupational therapy, physiotherapy, nutrition and
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8 related disciplines such as sports science and public health.
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11 Transferable Skills – An Overview
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13 Although the concept of transferable skills is a phenomenon attracting growing
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16 interest in higher education, it is not a well-defined notion. Various definitions have been
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18 offered. According to Drummond et al. (1998), transferable skills are skills that can be
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transferred to contexts outside the academic field of study. Bennett et al. (1999) define
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23 transferable skills as those “skills which can support study in any discipline, which can be
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25 potentially transferred to a range of contexts in higher education or the workplace” (p. 76),
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28 while Peter Kearns (2001) defines transferable skills as those skills “essential for
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30 employability, which are relevant at different levels for most” (p. 1). As illustrated in these
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33 definitions, the concept lacks a clear definition and is open to interpretative flexibility in
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35 relation to what transferable skills are (content) and to where skills may be transferred
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(context).
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40 While transferable skills is a rather ambiguously defined notion, it is commonly used

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as an overarching umbrella term encompassing diverse non-technical skills such as
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45 teamwork, critical thinking, problem solving, leadership, and so forth (e.g., Chan et al., 2017;
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47 Chan & Fong, 2018).
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50 The notion of transferable skill is but one of several related regularly used synonyms
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52 (Chan et al., 2017; Chan & Fong, 2018), for example soft skills (Succi, & Canovi, 2019),
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55 generic skills (Frenk et al., 2010), and personal skills (Elliott & Epstein, 2005), to name just a
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57 few (Chan et al., 2017). While some have used these terms interchangeably, others have
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considered them as reflecting different assumptions (Jones, 2013). Furthermore, these
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3 different terms are referred to as both attributes, competencies, and abilities without
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6 further consideration (Chan et al., 2017). For the sake of clarity throughout the remainder of
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8 this paper, we will adopt the notion ‘transferable skills’ as an overarching notion covering
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11 the abovementioned terms.
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13 Despite the blurred definition of transferable skills, there appears to be some
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16 consensus that transferable skills concern the application of skills across contexts, which
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18 implies an assumption of transferability of skills (Nägele & Stalder, 2017; Chan & Fong,
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2018). According to Barnett & Ceci (2002: 321), “transfer can be thought of as breaking
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23 down into two overall factors: the content—that is, what is transferred, and the context—
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25 that is, when and where it is transferred from and to”. Content can be categorized on a
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28 continuum between specific content (such as facts, routinized procedures) and general
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30 content (such as general concepts, problem-solving strategies). Context concerns how far
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33 apart the learning context is from the application context (i.e. near transfer vs. far transfer).
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35 However, none of the definitions of transferable skills precisely define the degree to which
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content is specific or general and the context is near or far.
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40 Research on how transferable skills and related terms are used in higher education is
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hampered by terminological confusion which limits the external generalizability of most
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45 empirical results in the field (Cook et al., 2007). It therefore seems urgent to scrutinize the
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47 conceptual boundaries of transferable skills in greater depth to reduce this conceptual
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50 confusion. This would provide a way forward for students and educators in higher education
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52 aiding their learning and teaching of transferable skills, and it would help researchers
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55 conduct systematic evaluations and empirical investigations of transferable skills.
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57 Purpose of the Present Study

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Hi
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3 The purpose of this mixed studies literature review was to explore the core
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6 characteristics of transferable skills in higher education literature. Thus, our study has two
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8 research questions. Firstly, we will create a typology of how the notion of transferable skills
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11 is conceptualized in order to identify the range of constituent elements of transferable skills
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13 proposed in the included studies. Secondly, we will use this typology to categorize the
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16 included quantitative studies investigating the effect of educational interventions. In this
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18 study, we will focus on health sciences education in higher education, because transferable
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skills are important for the future healthcare workforce to be able to adapt to ever changing
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23 circumstances of practice, such as the unpredictable health impacts of globalization
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25 (Moazzami et al., 2020), changing access to information and communication in communities
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28 (Schiavo, 2016), changing population demographics (Frenk et al., 2010; Crisp & Chen, 2014),
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30 or changing stakeholder expectations (Tobin-Tyler & Teitelbaum, 2016), just to mention a
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33 few examples. Ever changing circumstances of practice and the derived need for learning
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35 transferrable skills is relevant for professions in health science broadly speaking, and most
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likely also for many technical and vocational professions outside health science (e.g. law,
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40 business, engineering). We therefore pose the following questions:

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1. How are transferable skills conceptualized in the health sciences education research
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45 literature?
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47 2. What kind of quantitative evidence underpins the development of transferable skills
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50 in health sciences education?
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57 Design
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Hi
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3 In this study, we used the mixed studies literature review design. We applied the
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6 seven-stage procedure to conduct a sequential exploratory synthesis (Pluye and Hong,
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8 2014) of the included quantitative, qualitative, and mixed-methods studies
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11 1) Writing a review research question;
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13 2) Defining eligibility criteria;
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16 3) Applying an extensive search strategy in multiple information sources;
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18 4) Identifying potentially relevant studies;
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5) Selecting studies based on full text and extracting data;
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23 6) Synthesizing included studies using sequential exploratory synthesis;
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25 a. Qualitative synthesis
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30 7) Appraising the quality of included studies.
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33 According to Pluye and Hong (2014), this type of literature review is becoming
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35 popular as it provides a rich understanding of complex phenomena. Based on the two

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research questions above, we conducted the stages 2-7 in the following way:
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40 Stage 2: Eligibility Criteria

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The following inclusion criteria were deployed: (a) written in English; (b) published in
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45 a peer-reviewed journal; (c) explicit use of one of the chosen search terms (transferable,
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47 generic, 21st century, future, employability, key, personal, soft, and graduate) combined
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50 with different combinations of (skill*, competence*, attribute*, and capabilities) in abstract
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52 or title; (d) examining undergraduate or pre-graduate educations in health sciences (more

53
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55 specifically: medicine, dental, pharmacy, nurses, public health, chiropractors, psychology,
56
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57 physical therapy, physiotherapy, sports science, sports and exercise science, sports
58
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medicine, exercise physiology, and occupational therapy).
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3 Stage 3: Search Strategy
4
5
er
6 The search was commenced using the core databases in health sciences education:
7
8 Scopus, Embase, Web of Science, ProQuest, and Ebsco. The database search was performed
Ed
9
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11 on 4 July 2018.
12
u
13 Stage 4: Identifying Potentially Relevant Studies
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16 After removal of duplicates, 20% of the studies was randomly selected for
tio
17
18 investigator triangulation (Patton, 2002). Subsequently, the entire data set was screened for
19
20
eligibility by the lead investigator.
n,
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23 Stage 5: Selecting Relevant Studies Based on Full Text and Data Extraction
Sk
24
25 Data extraction included author details, year and country of publication, type of
26
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27
28 education, research method, and outcome measures used in each study. In addition, we
29
30 extracted all text segments (from few lines to half pages) of studies mentioning transferable
31
an
32
33 skills. All extracted data were uploaded in a data-extraction sheet. Then the text extracts
34
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35 were checked by the lead investigator to challenge the validity of the initial extraction.
36
37
38
Stage 6: Synthesizing Included Studies Using Sequential Exploratory Synthesis
39
or
40 Stage 6a (Phase One). We applied the reflexive thematic analysis and followed the
41
42
six-step approach of Braun & Clarke (2006; 2019) to identify overarching themes of how an
k-
43
44
45 ill-defined concept such as transferable skills is conceptualized. Thematic analysis has
Ba
46
47 previously been employed in literature reviews examining other ill-defined concepts such as
48
se
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50 resilience (Bryan et al., 2017; Patel et al., 2017; Barasa et al., 2018), creativity (Kampylis &
51
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52 Valtanen, 2010), and technology-enhanced learning (Kirkwood & Price, 2014). Thematic
53
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54
55 analysis involves identifying the intersections of the conceptualization of transferable skills
56
arn
57 from the included papers and subsequently determining the broader meaning patterns.
58
59
60
Consequently, we went beyond a descriptive account, expanding and extending data by
ing
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1
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2
3 going back and forth from data items to themes. The aim was to develop overarching
4
5
er
6 themes capturing key aspects of transferable skills. Themes were therefore defined as
7
8 concepts, which were repeated across the data set.
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9
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11 Stage 6b (phase two). The themes developed in phase one were used as data
12
u
13 containers to categorize the included quantitative studies in phase two, which investigated
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14
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16 the effect of educational interventions on the development of transferable skills. Studies
tio
17
18 were included if they used a quantitative experimental or observational design and had
19
20
objective outcome measures since we were interested in exploring factors that might have
n,
21
22
23 an impact on the development of transferable skills among students in health sciences
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24
25 education.
26
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28 Stage 7: Appraising the Quality of Included Studies
29
30 The methodologic quality of the included studies was assessed against the EPHPP
31
an
32
33 tool (Effective Public Health Practice Project, 1998a, 1998b) Quality Assessment Tool for
34
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35 Quantitative Studies. This appraisal tool has been considered fit for use in literature reviews
36
37
38
to assess methodological quality because 1) it is a generic tool suitable for evaluating a
39
or
40 variety of intervention study designs (Armijo-Olivo et al., 2012); 2) it uses a scoring system
41
42
with objective guidelines, which improves the consistency of raters’ scoring of study quality
k-
43
44
45 (Deeks et al., 2003). In addition, the tool has previously been applied in reviews examining
Ba
46
47 the quality of educational interventions (e.g., Bassir et al., 2013; Heckemann et al., 2015;
48
se
49
50 Härkänen et al., 2016).
51
d
52 The appraisal tool (EPHPP) comprises a global quality score based on predetermined
53
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55 criteria indicating the explicit information saturation of a study for the following
56
arn
57 components: (A) selection bias, (B) study design, (C) confounders, (D) blinding, (E) data
58
59
60
collection method, and (F) withdrawals / dropouts (Effective Public Health Practice Project,
ing
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2
3 1998a, 1998b). Consistent with the criteria in the companion document and rating all five
4
5
er
6 parts, we classified the studies as (1) strong (1 = no weak ratings), (2) moderate (2 = one
7
8 weak rating), or (3) weak (3 = two or more weak ratings).
Ed
9
10
11
12
u
13 RESULTS
ca
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15 A total of 152 studies fulfilled the inclusion criteria and formed the basis of our
16
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17
synthesis (Fig. 1). All included studies are listed in the Appendix.
18
19
20 Please insert Figure 1 here
n,
21
22 The distribution of transferable skills and related terms used in the 152 included
23
Sk
24
25 studies by publication year is seen in Figure 2. Figure 2 also shows that the use of
26
ills
27 transferable skills and related terms in health sciences literature has been increasing since
28
29
30 2001.
31
an

33
34
The majority of the included studies investigate students from medicine (n = 79,
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35
36
37 52%), nursing (n = 24, 16%), and psychology (n = 17, 11%). Others investigate students from
38
39 pharmacy (n = 7, 5%), inter-disciplines (n = 10, 7%), and physiotherapy (n = 6, 4%). Students
or
40
41
42 from sports science, public health, and occupational therapy represent 1% each. This result
k-
43
44 indicates that the emerging themes in the following results section is mostly representative
45
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46
47 of healthcare and health professionals’ education, especially medicine and nursing.
48
se
49 Emerging Themes
50
51
d
52 Examination of the range of conceptualizations within the included studies testifies

53
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54 to the absence of a widely accepted definition of transferable skills. Therefore, we could

55
56
identify no single global theme capturing how transferable skills are conceptualized. The
arn
57
58
59
60
ing
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3 thematic analysis revealed that the notion of transferable skills is conceptualized in three
4
5
er
6 distinct ways (Table 1).
7
8 The synthesis revealed that the meaning of transferable skills could be categorized
Ed
9
10
11 into three overarching themes: (1) Program Requirements, (2) Employability, and (3) Holistic
12
u
13 Development. These themes all concern the contexts of application of transferable skills.
ca
14
15
16 Hence, transferable skills were conceptualized as having an inherent directedness of
tio
17
18 application, and the three themes identified revealed the contexts in which transferable
19
20
skills were assumed to be applied. This thematic typology helped us distinguish between
n,
21
22
23 fundamental differences in contextual conceptualizations of transferable skills. The three
Sk
24
25 themes were occasionally present simultaneously in the same study (Table 1) even though
26
ills
27
28 they connote different properties. Thus, some studies used the notion of transferable skills
29
30 very broadly.
31
an
32
33 Please insert Table 1 here
34
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35 Despite differences in the terms assigned to transferable skills (e.g., generic, soft,
36
37
38
transferable, personal, key), the terms were used synonymously across the themes. Thus,
39
or
40 the terms themselves did not reflect differing sets of conceptual assumptions. This finding
41
42
was quite surprising given that the semantic differences between the terms could suggest
k-
43
44
45 term-specific content or meaning.
Ba
46
47 A comparison of the themes in relation to the embedded specific skills shows that
48
se
49
50 the skills generally do not differ across themes. Thus, the embedded specific skills (such as
51
d
52 information literacy, problem-solving, written and verbal communication) occurred equally

53
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55 across each of the three identified themes. For example, a specific skill (such as problem
56
arn
57 solving) could be conceptualized as being transferable both to an Employability context

58
59
60
(theme 2) and to a Holistic Development context (theme 3) simultaneously. This finding
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2
3 supports the suggested context-based typology where conceptualization of transferable
4
5
er
6 skills has an inherent directedness of application and not a specific type of skill as its core
7
8 meaning.
Ed
9
10
11 Interestingly, comparison of the themes revealed that the traditional classroom was
12
u
13 not necessarily regarded as the learning context in which transferable skills were developed.
ca
14
15
16 Thus, some of the studies forming the two subthemes of Employability and the theme of
tio
17
18 Holistic Development describe how work placement (e.g., reference number in Table 1: 89,
19
20
108, 125) or clinical simulation training (e.g., reference number in Table 1: 67, 114) was the
n,
21
22
23 learning context in which transferable skills would be acquired.
Sk
24
25 Having conceptualized what is meant by transferable skills in the literature, we use
26
ills
27
28 these themes as ‘data containers’ to categorize quantitative effect studies in the next phase
29
30 of this mixed studies review. The aim is to discuss the quantitative empirical evidence
31
an
32
33 underpinning the identified themes.
34
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35 Quantitative Effect Studies

36
37 Eight of the 152 included studies were quantitative effect studies using objective
38
39 outcome measures (see Table 2). They all conceptualized transferable skills as being related
or
40
41
42 to employability, either ‘future professional work’ or ‘future work’. However, only one study
k-
43
44 actually investigated transfer of skills from an educational context to an employment
45
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46
47 context (Mohamed et al., 2017). Six studies investigated the development of transferable
48
se
49 skills among students of medicine; five studies used observational cohort designs rather
50
51
d
52 than experimental designs (see Table 2). The size of the study populations varied from 51 to
53
Le
54 383 participants. The type of skills explored varied greatly (e.g., from interpersonal
55
56
competency, communication skills, collaborative problem solving, to self-assessment skills,
arn
57
58
59 etc.), and there were no indications that the research converged on any single skill.
60
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2
3 Please insert Table 2 here.
4
5
er
6 Table 3 shows the critical appraisal scores, which were given according to the EPHPP
7
8 tool. All studies received a weak global quality score based on the information available.
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9
10
11 Weaker ratings were frequently due to methodological or reporting issues related to
12
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13 blinding. In contrast, study designs and withdrawal/drop-out were, relatively speaking,
ca
14
15
16 stronger features of the studies appraised (see Table 3).
tio
17
19
20
n,
21
22 DISCUSSION
23
Sk
24 The aim of this mixed studies review was to examine how transferable skills are
25
26
conceptualized and subsequently to investigate which educational interventions could
ills
27
28
29 promote the development of transferable skills according to current literature in health
30
31
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sciences education. Firstly, we found that transferable skills are conceptualized as having an
32
33
34 inherent directedness of application in relation to (1) Program Requirements, (2)
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35
36 Employability, and (3) Holistic Development. Secondly, we found that the empirical evidence
37
38
39 appraised was too weak and heterogeneous to underpin any particular educational
or
40
41 intervention promoting the development of transferable skills.
42
k-
43
44 How Are Transferable Skills Conceptualized?
45
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46
Comparing existing definitions and conceptual models is an important first step in
47
48 clarifying the substantive features of transferable skills. In this regard, each of the three
se
49
50 themes identified can separately be matched with conceptualizations described in earlier
51
d
52
53 studies, but no coherent typology of these conceptualizations has yet been offered.
Le
54
55 In accordance with our findings of the two subthemes ‘entrance requirements’ and
56
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58 ‘early academic success’, which are embedded within the theme of Program Requirements,
59
60 Barrie (2006) describes precursor skills (skills that are the basics or even a prerequisite for
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3 university entry) and complement skills (skills that help round out students’ disciplinary
4
5
er
6 learning). The former corresponds to the subtheme of ‘entrance requirements’ and the
7
8 latter to ‘early academic success’. However, the subtheme of ‘course outcome’ is not found
Ed
9
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11 in Barrie’s framework. In contrast, Barrie describes two types of transferable skills that we
12
u
13 did not detect in our analysis. These are translation skills (skills essential in applying
ca
14
15
16 disciplinary knowledge in non-disciplinary settings) and enabling skills (skills that facilitate
tio
17
18 scholarly abilities of transposing university experiences into original creations of thoughts
19
20
and, ideally, contribution to society). Translation skills and enabling skills seem to
n,
21
22
23 correspond to David Bridges’ (1993) definition of transferring skills: “These are as it were
Sk
24
25 the meta-skills, the second order skills which enable one to select, adapt, adjust and apply
26
ills
27
28 one's other skills to different situations, across different social contexts" (Bridges, 1993: 50).
29
30 In contrast, Bridges (1993) defines transferable skills as skills that can be deployed with little
31
an
32
33 or no adaptation in a variety of social settings (Bridges, 1993: 50). The social settings
34
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35 identified in our review were either higher education contexts (theme 1), employment
36
37
38
contexts (theme 2), or life in general (theme 3).
39
or
40 Consistent with previous frameworks (e.g., Suleman, 2018; Barbosa, 2017), this
41
42
review confirms that transferable skills are associated with development of skills for
k-
43
44
45 employment, either general skills required for various jobs or skills required for specific jobs.
Ba
46
47 Our theme of Employability therefore matches previously described frameworks of
48
se
49
50 transferable skills. In addition, the distinction between discipline-specific skills and generic
51
d
52 transferable skills in terms of employability also emerges in some of the leading conceptual
53
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55 frameworks of employability as a concept in higher education research (Römgens et al.,
56
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57 2019).
58
59
60
ing
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3 Consistent with previous studies, this review confirms that the concept of
4
5
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6 transferable skills is associated with holistic development in relation to whole-person
7
8 development (Chan et al., 2017). Thus, this context of application has previously been
Ed
9
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11 proposed in relation to the concept of transferable skills (Chan & Fong, 2018).
12
u
13 The Three Themes in a Transfer Theoretical Perspective
ca
14
15 Comparison of the present findings with those of other studies confirms that
16
tio
17
transferable skills are conceptualized as having an inherent directedness of application to
18
19
20 novel and different contexts (Nägele & Stalder, 2017; Barbosa et al., 2017). A possible
n,
21
22 explanation for this may be that the notion of transferable skills is used in the literature as a
23
Sk
24
25 way of emphasizing the assumed transferability of the embedded specific skills. The three
26
ills
27 themes we identified demonstrate the various contexts in which it is anticipated that

28
29
30 transferable skills are applied. Surprisingly, the learning context was not necessarily
31
an
32 regarded as higher education, as noted in the result section.

33
34
In the introduction section, we outlined the view on context (near transfer vs. far
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35
36
37 transfer) articulated by Barnett & Ceci (2002) according to which near transfer refers to the
38
39 close similarity between the context in which knowledge and skills are acquired and in
or
40
41
42 which they are used. Far transfer, on the other hand, is characterized by the use of
k-
43
44 knowledge or skills across contexts with few identical elements (Barnett and Ceci, 2002). In
45
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47 this transfer theoretical perspective (near transfer vs. far transfer), our themes appear to be
48
se
49 multidimensional as the studies from which the themes derive vary in their view on what
50
51
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52 constitutes the learning context and the application contexts.

53
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54 The subthemes in the theme Program Requirements (theme 1) cannot easily be

55
56
categorized on the continuum of transfer distance (i.e. near vs. far transfer). The subtheme
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59 ‘early academic success’ contains studies describing the learning context of transferable
60
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3 skills, like the university itself (i.e. near transfer), or prior skills developed before entering
4
5
er
6 higher education, which then are expected to be transferred and refined in higher education
7
8 (i.e. far transfer). The studies forming the subtheme of ‘entrance requirement’ contextualize
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9
10
11 a non-university context as the context in which transferable skills are developed.
12
u
13 Moreover, selection of applicants implies selection of applicants’ prior skills, which are
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14
15
16 assumed to be transferred into the program (i.e. far transfer). The studies constituting the
tio
17
18 subtheme ‘course outcome’ articulate no specific contexts of application wherefore the
19
20
continuum is unsuitable for this subtheme.
n,
21
22
23 The majority of the studies forming Employability (theme 2) and Holistic
Sk
24
25 Development (theme 3) implicitly or explicitly assume far transfer because higher education
26
ills
27
28 is described as the learning context, and the labor market or life in general is described as
29
30 the application context. These two different contexts were quite dissimilar and remote to
31
an
32
33 one another as they shared only few identical elements. In contrast, the remaining studies
34
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35 encompassing these themes (Employability and Holistic Development) implicitly or explicitly

36
37
38
assumed nearer transfer. Thus, simulated settings, work placements, or internships were
39
or
40 described as the learning contexts in which transferable skills were acquired. By using
41
42
learning contexts sharing similarities with the context of application, the distance of transfer
k-
43
44
45 is reduced (Blume, Ford, Baldwin & Huang, 2010). The closer the link between the learning
Ba
46
47 context and the application context, the better are the prospects of stimulating transfer,
48
se
49
50 since it is easier to transfer knowledge and skills between contexts that share similarities
51
d
52 (Grossman & Salas, 2011). Consequently, the acquisition of transferable skills could be
53
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54
55 enhanced if the skills are developed in the contexts anticipating their application.
56
arn
57 What Underpins the Development of Transferable Skills?

58
59
60
ing
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1
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2
3 Our review echoes previous reviews, substantiating that the educational
4
5
er
6 interventions performed with the EPHPP tool have modest generalizability beyond the
7
8 settings in which they were conducted. For example, Härkänen et al. (2016) conducted a
Ed
9
10
11 systematic review and meta-analysis of educational interventions designed to improve
12
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13 medication administration skills and safety for registered nurses. Thus, among 14 studies
ca
14
15
16 reviewed, one study was rated as being of strong quality, four studies as being of moderate
tio
17
18 quality, and nine studies as being of weak quality. Similarly, conducting a narrative review of
19
20
nine studies of the effect of aggression training programs for nursing staff and students
n,
21
22
23 working in an acute hospital setting, Heckemann et al. (2015) rated one study as being of
Sk
24
25 strong quality, six studies as being of moderate quality, and two studies as being of weak
26
ills
27
28 quality. In other words, according to the EPHPP criteria, studies of educational interventions
29
30 fall short of achieving high quality, as also concluded in other reviews (e.g., Hersch et al.,
31
an
32
33 2014; Price et al., 2015). Several explanations why studies on educational interventions
34
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35 obtain a lower global quality score may be on the table. In our case, blinding seemed to be a
36
37
38
particular issue as only one study reported on blinding of outcome assessors (Bargouti et al.,
39
or
40 2013) and none on blinding of study participants. This lack of blinding meant that the
41
42
majority of studies could not achieve a higher global rating score than ‘moderate’ because
k-
43
44
45 of the EPHPP scoring system. It is, however, important to bear in mind that although
Ba
46
47 blinding is an important methodological feature (Karanicolas et al., 2010), blinding of
48
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49
50 outcome assessors and study participants often cannot be done for practical or ethical
51
d
52 reasons in authentic and naturalistic educational settings. If outcome assessors actively

53
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54
55 provide or somehow contribute to the educational intervention (Roberts et al., 2005),
56
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57 blinding is jeopardized. Blinding of study participants so that they are prevented from
58
59
60
knowing the aim of the educational intervention might also be difficult in some contexts,
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3 because students might deduce or obtain information about whether they received the
4
5
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6 educational intervention or not. In addition, ethical considerations were found to obstruct
7
8 blinding in one instance where researchers collected a written consent in advance of the
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9
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11 study to ensure good ethical standards and thereby revealed the research questions
12
u
13 (Roberts et al., 2005).
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14
15
16 All eight studies conceptualized transferable skills as concerning Employability.
tio
17
18 However, only one study investigated transfer of skills from an educational context to an
19
20
employment context (Mohamed et al., 2017). Thus, in the majority of studies, the outcome
n,
21
22
23 measures appeared misaligned with the conceptual objective of examining transfer of skills
Sk
24
25 to a work context. The studies mainly investigated students’ performance within higher
26
ills
27
28 education and not the extent to which they actually transferred acquired skills to an
29
30 employment context (Kaufman & Keller, 1994; Praslova, 2010). For educational strategies
31
an
32
33 aimed at developing students’ employability skills to be effective, they must be research
34
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35 based and focused on the transfer of skills acquired in educational contexts to job settings
36
37
38
(Bewley & O’Neil, 2013).
39
or
40 Limitation of the Present Study

41
42
This review has certain limitations. The fact that a single researcher conducted most
k-
43
44
45 of the study selection and data extraction independently is a limitation that might challenge
Ba
46
47 the strength of the review. However, we took this limitation into account in several ways.
48
se
49
50 Firstly, we established a clearly defined set of inclusion criteria through investigator
51
d
52 triangulation (Patton, 2002), which minimized subjectivity in study selection. Secondly, we

53
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54
55 randomly selected a sample of 20% of studies for investigator triangulation (Patton, 2002).
56
arn
57 Thirdly, it is not required that more researchers locate every available study in a thematic
58
59
60
analysis because the results of a conceptualization are not based on the exact number of
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3 studies describing the same concept (Thomas & Harden, 2008). This point provides some
4
5
er
6 reassurance that excluded studies would not fundamentally alter the nature of the themes
7
8 identified (Partel et al., 2017). Thus, we conceptualized themes as broad concepts that were
Ed
9
10
11 repeated across the data set.
12
u
13 Finally, analyzing and presenting the results of the thematic analysis were
ca
14
15
16 challenging tasks. We applied the reflexive thematic analysis described by Braun & Clark
tio
17
18 (2006; 2019) in the analysis and conceptualization of the themes. Hence, the themes are
19
20
quite abstract compared to the explicit content in the studies (Braun & Clark, 2019). The
n,
21
22
23 reliability of the reflexive thematic analysis might therefore be contested since the
Sk
24
25 development of themes depends on the reviewer’s judgment and insight (Thomas &
26
ills
27
28 Harden, 2008). We tackled this challenge by developing themes in an iterative process
29
30 between two researchers and by securing transparency via displaying what led to the
31
an
32
33 developed themes. Consequently, the readers have the opportunity to judge for themselves
34
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35 whether our themes capture the key components of transferable skills as a concept in the
36
37
38
health science literature.
39
or
40
41
42
CONCLUSION AND PERSPECTIVES
k-
43
44
45 This review, the first of its kind, aimed to examine conceptualizations of transferable
Ba
46
47 skills and interventions that may underpin their development in health science education.
48
se
49
50 Within health sciences education, the literature on transferable skills were concentrated in
51
d
52 healthcare and health professionals’ education, especially medicine and nursing. While the
53
Le
54
55 conceptualizations of transferable skills differ considerably in the broader literature, the
56
arn
57 results show that in health science education transferable skills reflected three main
58
59
60
ing
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1
gh
2
3 Consequently, this review has implications for health sciences education because
4
5
er
6 transferable skills are important for the future healthcare workforce to be able to adapt to
7
8 ever changing circumstances of practice. In this regard, our findings provide an
Ed
9
10
11 understanding of transferable skills contributing to creating a basis for curriculum
12
u
13 development and empirical research on how to develop and assess transferable skills in
ca
14
15
16 future healthcare workers. According to Green et al., (2009), conceptual clarity is important
tio
17
18 for the teaching of transferable skills because well-defined learning objectives provide 1)
19
20
educators with a clear purpose to focus their teaching efforts; 2) direct educators’ choice of
n,
21
22
23 relevant teaching strategies; and 3) guide educators’ assessment strategies. The three
Sk
24
25 identified themes therefore provide a conceptual foundation for aligning teaching and
26
ills
27
28 assessment strategies with intended learning objectives in transferable skills curricula.
29
30 The review has also implications for future research. We found that the global
31
an
32
33 methodological quality of the empirical studies in this review was sparse and weak. Current
34
dW
35 literature therefore does not support specific educational interventions for transferable
36
37
38
skills development among undergraduate students. Future empirical effect studies on
39
or
40 transferrable skills of a higher methodological quality are therefore needed. However,

41
42
sufficient conceptual precision is of paramount importance regardless of methodological
k-
43
44
45 quality because its absence severely threatens the validity of empirical research. In addition,
Ba
46
47 lack of conceptual precision has practical implications for teaching, learning, and assessment
48
se
49
50 in higher education. Hence, it is important to be aware of the transfer theoretical
51
d
52 perspective, that is the relation between the learning context and the application context
53
Le
54
55 (near transfer vs. far transfer), when using the notion of transferable skills and other related
56
arn
57 terms in empirical studies. The three themes identified in our study are the first step in
58
59
60
clarifying what the concept of transferable skills actually implies in current research in
ing
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2
3 health science education. Conceptual clarity is crucial for the validly of future empirical
4
5
er
6 studies investigating students’ development of transferable skills, not just in health sciences
7
8 education but also in higher education generally. We therefore invite future research to
Ed
9
10
11 draw on our conceptualization of transferable skills as a point of departure for 1)
12
u
13 investigations of how and when the concept is applied, and for 2) empirical research on how
ca
14
15
16 to develop and assess transferable skills in order to afford students the opportunity to adapt
tio
17
18 to future change – in higher education and in the labor marked – in a flexible and
19
20
competent way.
n,
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22
23
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24 Declarations of interest: This research did not receive any specific grant from funding
25
26
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https://doi.org/10.1097/ACM.0000000000000943
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40 Universities UK. (2018, August), Solving Future Skills Challenges, available at

41
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45 analysis/reports/Documents/2018/solving-future-skills-challenges.pdf.
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3 WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A LITERATURE REVIEW OF HOW THE
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6 CONCEPT IS CONCEPTUALIZED IN UNDERGRADUATE HEALTH SCIENCES EDUCATION
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8
Ed
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11 ABSTRACT
12
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13 Purpose: Due to rapid changes in the future labor market, transferable skills are recognized
ca
14
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16 as a vital learning outcome for students in undergraduate higher education. However,
tio
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18 ambiguities surrounding the concept and content of transferable skills hampers the actual
19
20
teaching and learning of transferable skills. Consequently, there is a great need for an
n,
21
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23 overview of the literature on transferable skills to qualify and develop our approaches to
Sk
24
25 transferrable skills in higher education. This study aims to outline a typology of how
26
ills
27
28 transferable skills are conceptualized in health sciences education, that is medicine, nursing
29
30 and related health professionals education.
31
an
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33 Design: The study was a mixed studies literature review, which included quantitative,
34
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35 qualitative, and mixed-methods studies. A seven-stage sequential exploratory synthesis of

36
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38
the included studies was conducted.
39
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40 Findings: This review showed that transferable skills reflected three main
41
42
k-
43
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45 Overall, the global methodological quality of the empirical studies of interventions to
Ba
46
47 further transferable skills development in health science education was weak.
48
se
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50 Practical implications: By distinguishing between three main conceptualizations of
51
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52 transferable skills, this study’s typology supports alignment in transferable skills curricula
53
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54
55 because conceptually sound learning objectives provide teachers and students in health
56
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57 sciences educations with a clear purpose, and direct educators’ choice of relevant teaching
58
59
60
and assessment strategies.
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2
3 Research implications: Last, but not least, this study aids clear conceptualization in future
4
5
er
6 empirical studies.
7
8 Originality: This review – the first of its kind – contributes to conceptualization of
Ed
9
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11 transferable skills as the basis for curriculum development and research.
12
u
13
ca
14
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16 Keywords: health science education; higher education; literature review; transfer; generic
tio
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18 skills; employability.
19
20
n,
21
22
23 INTRODUCTION
Sk
24
25 Due to rapid changes in the future labor market, transferable skills are widely
26
ills
27
28 recognized as a vital learning outcome for students in higher education (European Union,
29
30 2011; European Union, 2016; OECD, 2016; Universities UK, 2018; Succi, & Canovi, 2019).
31
an
32
33 Transferable skills are assumed an essential prerequisite for developing graduates’
34
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35 adaptability, flexibility, and employability, affording them the opportunity to rapidly adapt
36
37
38
to future change (Jones et al., 2010; EU, 2016; Succi, & Canovi, 2019). However, the
39
or
40 conceptual vagueness and ambiguity concerning both the concept and the content of
41
42
transferable skills hamper the actual teaching and learning of transferable skills (Kember et
k-
43
44
45 al., 2007; Green et al., 2009; Jääskelä et al., 2018). The lack of conceptual alignment and the
Ba
46
47 lack of content specificity also threaten evaluation and empirical investigation of
48
se
49
50 transferable skills (Strijbos et al., 2015; Chan et al., 2017). Consequently, there is a great
51
d
52 need for a overview of the literature on transferable skills to r support students’

53
Le
54
55 development of such skills. This mixed studies literature review (Pluye and Hong, 2014)
56
arn
57 outlines a typology of how transferable skills are conceptualized and empirically

58
59
60
investigated in the field of health sciences education (HSE), that is the bachelors and/or
ing
Hi
1
gh
2
3 masters level of educational programs within healthcare, health profession and health
4
5
er
6 sciences such as medicine, nursing, occupational therapy, physiotherapy, nutrition and
7
8 related disciplines such as sports science and public health.
Ed
9
10
11 Transferable Skills – An Overview
12
u
13 Although the concept of transferable skills is a phenomenon attracting growing
ca
14
15
16 interest in higher education, it is not a well-defined notion. Various definitions have been
tio
17
18 offered. According to Drummond et al. (1998), transferable skills are skills that can be
19
20
transferred to contexts outside the academic field of study. Bennett et al. (1999) define
n,
21
22
23 transferable skills as those “skills which can support study in any discipline, which can be
Sk
24
25 potentially transferred to a range of contexts in higher education or the workplace” (p. 76),
26
ills
27
28 while Peter Kearns (2001) defines transferable skills as those skills “essential for
29
30 employability, which are relevant at different levels for most” (p. 1). As illustrated in these
31
an
32
33 definitions, the concept lacks a clear definition and is open to interpretative flexibility in
34
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35 relation to what transferable skills are (content) and to where skills may be transferred
36
37
38
(context).
39
or
40 While transferable skills is a rather ambiguously defined notion, it is commonly used

41
42
as an overarching umbrella term encompassing diverse non-technical skills such as
k-
43
44
45 teamwork, critical thinking, problem solving, leadership, and so forth (e.g., Chan et al., 2017;
Ba
46
47 Chan & Fong, 2018).
48
se
49
50 The notion of transferable skill is but one of several related regularly used synonyms
51
d
52 (Chan et al., 2017; Chan & Fong, 2018), for example soft skills (Succi, & Canovi, 2019),
53
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54
55 generic skills (Frenk et al., 2010), and personal skills (Elliott & Epstein, 2005), to name just a
56
arn
57 few (Chan et al., 2017). While some have used these terms interchangeably, others have
58
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60
considered them as reflecting different assumptions (Jones, 2013). Furthermore, these
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3 different terms are referred to as both attributes, competencies, and abilities without
4
5
er
6 further consideration (Chan et al., 2017). For the sake of clarity throughout the remainder of
7
8 this paper, we will adopt the notion ‘transferable skills’ as an overarching notion covering
Ed
9
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11 the abovementioned terms.
12
u
13 Despite the blurred definition of transferable skills, there appears to be some
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16 consensus that transferable skills concern the application of skills across contexts, which
tio
17
18 implies an assumption of transferability of skills (Nägele & Stalder, 2017; Chan & Fong,
19
20
2018). According to Barnett & Ceci (2002: 321), “transfer can be thought of as breaking
n,
21
22
23 down into two overall factors: the content—that is, what is transferred, and the context—
Sk
24
25 that is, when and where it is transferred from and to”. Content can be categorized on a
26
ills
27
28 continuum between specific content (such as facts, routinized procedures) and general
29
30 content (such as general concepts, problem-solving strategies). Context concerns how far
31
an
32
33 apart the learning context is from the application context (i.e. near transfer vs. far transfer).
34
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35 However, none of the definitions of transferable skills precisely define the degree to which
36
37
38
content is specific or general and the context is near or far.
39
or
40 Research on how transferable skills and related terms are used in higher education is
41
42
hampered by terminological confusion which limits the external generalizability of most
k-
43
44
45 empirical results in the field (Cook et al., 2007). It therefore seems urgent to scrutinize the
Ba
46
47 conceptual boundaries of transferable skills in greater depth to reduce this conceptual
48
se
49
50 confusion. This would provide a way forward for students and educators in higher education
51
d
52 aiding their learning and teaching of transferable skills, and it would help researchers
53
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55 conduct systematic evaluations and empirical investigations of transferable skills.
56
arn
57 Purpose of the Present Study

58
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60
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3 The purpose of this mixed studies literature review was to explore the core
4
5
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6 characteristics of transferable skills in higher education literature. Thus, our study has two
7
8 research questions. Firstly, we will create a typology of how the notion of transferable skills
Ed
9
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11 is conceptualized in order to identify the range of constituent elements of transferable skills
12
u
13 proposed in the included studies. Secondly, we will use this typology to categorize the
ca
14
15
16 included quantitative studies investigating the effect of educational interventions. In this
tio
17
18 study, we will focus on health sciences education in higher education, because transferable
19
20
skills are important for the future healthcare workforce to be able to adapt to ever changing
n,
21
22
23 circumstances of practice, such as the unpredictable health impacts of globalization
Sk
24
25 (Moazzami et al., 2020), changing access to information and communication in communities
26
ills
27
28 (Schiavo, 2016), changing population demographics (Frenk et al., 2010; Crisp & Chen, 2014),
29
30 or changing stakeholder expectations (Tobin-Tyler & Teitelbaum, 2016), just to mention a
31
an
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33 few examples. Ever changing circumstances of practice and the derived need for learning
34
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35 transferrable skills is relevant for professions in health science broadly speaking, and most
36
37
38
likely also for many technical and vocational professions outside health science (e.g. law,
39
or
40 business, engineering). We therefore pose the following questions:

41
42
1. How are transferable skills conceptualized in the health sciences education research
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43
44
45 literature?
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47 2. What kind of quantitative evidence underpins the development of transferable skills
48
se
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50 in health sciences education?
51
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52
53
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55 METHOD
56
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57 Design
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60
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3 In this study, we used the mixed studies literature review design. We applied the
4
5
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6 seven-stage procedure to conduct a sequential exploratory synthesis (Pluye and Hong,
7
8 2014) of the included quantitative, qualitative, and mixed-methods studies
Ed
9
10
11 1) Writing a review research question;
12
u
13 2) Defining eligibility criteria;
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14
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16 3) Applying an extensive search strategy in multiple information sources;
tio
17
18 4) Identifying potentially relevant studies;
19
20
5) Selecting studies based on full text and extracting data;
n,
21
22
23 6) Synthesizing included studies using sequential exploratory synthesis;
Sk
24
25 a. Qualitative synthesis
26
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28 b. Quantitative synthesis
29
30 7) Appraising the quality of included studies.
31
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33 According to Pluye and Hong (2014), this type of literature review is becoming
34
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35 popular as it provides a rich understanding of complex phenomena. Based on the two

36
37
38
research questions above, we conducted the stages 2-7 in the following way:
39
or
40 Stage 2: Eligibility Criteria

41
42
The following inclusion criteria were deployed: (a) written in English; (b) published in
k-
43
44
45 a peer-reviewed journal; (c) explicit use of one of the chosen search terms (transferable,
Ba
46
47 generic, 21st century, future, employability, key, personal, soft, and graduate) combined
48
se
49
50 with different combinations of (skill*, competence*, attribute*, and capabilities) in abstract
51
d
52 or title; (d) examining undergraduate or pre-graduate educations in health sciences (more

53
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55 specifically: medicine, dental, pharmacy, nurses, public health, chiropractors, psychology,
56
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57 physical therapy, physiotherapy, sports science, sports and exercise science, sports
58
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medicine, exercise physiology, and occupational therapy).
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3 Stage 3: Search Strategy
4
5
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6 The search was commenced using the core databases in health sciences education:
7
8 Scopus, Embase, Web of Science, ProQuest, and Ebsco. The database search was performed
Ed
9
10
11 on 4 July 2018.
12
u
13 Stage 4: Identifying Potentially Relevant Studies
ca
14
15
16 After removal of duplicates, 20% of the studies was randomly selected for
tio
17
18 investigator triangulation (Patton, 2002). Subsequently, the entire data set was screened for
19
20
eligibility by the lead investigator.
n,
21
22
23 Stage 5: Selecting Relevant Studies Based on Full Text and Data Extraction
Sk
24
25 Data extraction included author details, year and country of publication, type of
26
ills
27
28 education, research method, and outcome measures used in each study. In addition, we
29
30 extracted all text segments (from few lines to half pages) of studies mentioning transferable
31
an
32
33 skills. All extracted data were uploaded in a data-extraction sheet. Then the text extracts
34
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35 were checked by the lead investigator to challenge the validity of the initial extraction.
36
37
38
Stage 6: Synthesizing Included Studies Using Sequential Exploratory Synthesis
39
or
40 Stage 6a (Phase One). We applied the reflexive thematic analysis and followed the
41
42
six-step approach of Braun & Clarke (2006; 2019) to identify overarching themes of how an
k-
43
44
45 ill-defined concept such as transferable skills is conceptualized. Thematic analysis has
Ba
46
47 previously been employed in literature reviews examining other ill-defined concepts such as
48
se
49
50 resilience (Bryan et al., 2017; Patel et al., 2017; Barasa et al., 2018), creativity (Kampylis &
51
d
52 Valtanen, 2010), and technology-enhanced learning (Kirkwood & Price, 2014). Thematic
53
Le
54
55 analysis involves identifying the intersections of the conceptualization of transferable skills
56
arn
57 from the included papers and subsequently determining the broader meaning patterns.
58
59
60
Consequently, we went beyond a descriptive account, expanding and extending data by
ing
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1
gh
2
3 going back and forth from data items to themes. The aim was to develop overarching
4
5
er
6 themes capturing key aspects of transferable skills. Themes were therefore defined as
7
8 concepts, which were repeated across the data set.
Ed
9
10
11 Stage 6b (phase two). The themes developed in phase one were used as data
12
u
13 containers to categorize the included quantitative studies in phase two, which investigated
ca
14
15
16 the effect of educational interventions on the development of transferable skills. Studies
tio
17
18 were included if they used a quantitative experimental or observational design and had
19
20
objective outcome measures since we were interested in exploring factors that might have
n,
21
22
23 an impact on the development of transferable skills among students in health sciences
Sk
24
25 education.
26
ills
27
28 Stage 7: Appraising the Quality of Included Studies
29
30 The methodologic quality of the included studies was assessed against the EPHPP
31
an
32
33 tool (Effective Public Health Practice Project, 1998a, 1998b) Quality Assessment Tool for
34
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35 Quantitative Studies. This appraisal tool has been considered fit for use in literature reviews
36
37
38
to assess methodological quality because 1) it is a generic tool suitable for evaluating a
39
or
40 variety of intervention study designs (Armijo-Olivo et al., 2012); 2) it uses a scoring system
41
42
with objective guidelines, which improves the consistency of raters’ scoring of study quality
k-
43
44
45 (Deeks et al., 2003). In addition, the tool has previously been applied in reviews examining
Ba
46
47 the quality of educational interventions (e.g., Bassir et al., 2013; Heckemann et al., 2015;
48
se
49
50 Härkänen et al., 2016).
51
d
52 The appraisal tool (EPHPP) comprises a global quality score based on predetermined
53
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55 criteria indicating the explicit information saturation of a study for the following
56
arn
57 components: (A) selection bias, (B) study design, (C) confounders, (D) blinding, (E) data
58
59
60
collection method, and (F) withdrawals / dropouts (Effective Public Health Practice Project,
ing
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2
3 1998a, 1998b). Consistent with the criteria in the companion document and rating all five
4
5
er
6 parts, we classified the studies as (1) strong (1 = no weak ratings), (2) moderate (2 = one
7
8 weak rating), or (3) weak (3 = two or more weak ratings).
Ed
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11
12
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13 RESULTS
ca
14
15 A total of 152 studies fulfilled the inclusion criteria and formed the basis of our
16
tio
17
synthesis (Fig. 1). All included studies are listed in the Appendix.
18
19
n,
21
22 The distribution of transferable skills and related terms used in the 152 included
23
Sk
24
25 studies by publication year is seen in Figure 2. Figure 2 also shows that the use of
26
ills
27 transferable skills and related terms in health sciences literature has been increasing since
28
29
30 2001.
31
an

33
34
The majority of the included studies investigate students from medicine (n = 79,
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35
36
37 52%), nursing (n = 24, 16%), and psychology (n = 17, 11%). Others investigate students from
38
39 pharmacy (n = 7, 5%), inter-disciplines (n = 10, 7%), and physiotherapy (n = 6, 4%). Students
or
40
41
42 from sports science, public health, and occupational therapy represent 1% each. This result
k-
43
44 indicates that the emerging themes in the following results section is mostly representative
45
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46
47 of healthcare and health professionals’ education, especially medicine and nursing.
48
se
49 Emerging Themes
50
51
d
52 Examination of the range of conceptualizations within the included studies testifies

53
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54 to the absence of a widely accepted definition of transferable skills. Therefore, we could

55
56
identify no single global theme capturing how transferable skills are conceptualized. The
arn
57
58
59
60
ing
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3 thematic analysis revealed that the notion of transferable skills is conceptualized in three
4
5
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6 distinct ways (Table 1).
7
8 The synthesis revealed that the meaning of transferable skills could be categorized
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9
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11 into three overarching themes: (1) Program Requirements, (2) Employability, and (3) Holistic
12
u
13 Development. These themes all concern the contexts of application of transferable skills.
ca
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15
16 Hence, transferable skills were conceptualized as having an inherent directedness of
tio
17
18 application, and the three themes identified revealed the contexts in which transferable
19
20
skills were assumed to be applied. This thematic typology helped us distinguish between
n,
21
22
23 fundamental differences in contextual conceptualizations of transferable skills. The three
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24
25 themes were occasionally present simultaneously in the same study (Table 1) even though
26
ills
27
28 they connote different properties. Thus, some studies used the notion of transferable skills
29
30 very broadly.
31
an
32
33 Please insert Table 1 here
34
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35 Despite differences in the terms assigned to transferable skills (e.g., generic, soft,
36
37
38
transferable, personal, key), the terms were used synonymously across the themes. Thus,
39
or
40 the terms themselves did not reflect differing sets of conceptual assumptions. This finding
41
42
was quite surprising given that the semantic differences between the terms could suggest
k-
43
44
45 term-specific content or meaning.
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46
47 A comparison of the themes in relation to the embedded specific skills shows that
48
se
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50 the skills generally do not differ across themes. Thus, the embedded specific skills (such as
51
d
52 information literacy, problem-solving, written and verbal communication) occurred equally

53
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55 across each of the three identified themes. For example, a specific skill (such as problem
56
arn
57 solving) could be conceptualized as being transferable both to an Employability context

58
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60
(theme 2) and to a Holistic Development context (theme 3) simultaneously. This finding
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2
3 supports the suggested context-based typology where conceptualization of transferable
4
5
er
6 skills has an inherent directedness of application and not a specific type of skill as its core
7
8 meaning.
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9
10
11 Interestingly, comparison of the themes revealed that the traditional classroom was
12
u
13 not necessarily regarded as the learning context in which transferable skills were developed.
ca
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16 Thus, some of the studies forming the two subthemes of Employability and the theme of
tio
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18 Holistic Development describe how work placement (e.g., reference number in Table 1: 89,
19
20
108, 125) or clinical simulation training (e.g., reference number in Table 1: 67, 114) was the
n,
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22
23 learning context in which transferable skills would be acquired.
Sk
24
25 Having conceptualized what is meant by transferable skills in the literature, we use
26
ills
27
28 these themes as ‘data containers’ to categorize quantitative effect studies in the next phase
29
30 of this mixed studies review. The aim is to discuss the quantitative empirical evidence
31
an
32
33 underpinning the identified themes.
34
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35 Quantitative Effect Studies

36
37 Eight of the 152 included studies were quantitative effect studies using objective
38
39 outcome measures (see Table 2). They all conceptualized transferable skills as being related
or
40
41
42 to employability, either ‘future professional work’ or ‘future work’. However, only one study
k-
43
44 actually investigated transfer of skills from an educational context to an employment
45
Ba
46
47 context (Mohamed et al., 2017). Six studies investigated the development of transferable
48
se
49 skills among students of medicine; five studies used observational cohort designs rather
50
51
d
52 than experimental designs (see Table 2). The size of the study populations varied from 51 to
53
Le
54 383 participants. The type of skills explored varied greatly (e.g., from interpersonal
55
56
competency, communication skills, collaborative problem solving, to self-assessment skills,
arn
57
58
59 etc.), and there were no indications that the research converged on any single skill.
60
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2
4
5
er
6 Table 3 shows the critical appraisal scores, which were given according to the EPHPP
7
8 tool. All studies received a weak global quality score based on the information available.
Ed
9
10
11 Weaker ratings were frequently due to methodological or reporting issues related to
12
u
13 blinding. In contrast, study designs and withdrawal/drop-out were, relatively speaking,
ca
14
15
16 stronger features of the studies appraised (see Table 3).
tio
17
19
20
n,
21
22 DISCUSSION
23
Sk
24 The aim of this mixed studies review was to examine how transferable skills are
25
26
conceptualized and subsequently to investigate which educational interventions could
ills
27
28
29 promote the development of transferable skills according to current literature in health
30
31
an
sciences education. Firstly, we found that transferable skills are conceptualized as having an
32
33
34 inherent directedness of application in relation to (1) Program Requirements, (2)
dW
35
36 Employability, and (3) Holistic Development. Secondly, we found that the empirical evidence
37
38
39 appraised was too weak and heterogeneous to underpin any particular educational
or
40
41 intervention promoting the development of transferable skills.
42
k-
43
44 How Are Transferable Skills Conceptualized?
45
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46
Comparing existing definitions and conceptual models is an important first step in
47
48 clarifying the substantive features of transferable skills. In this regard, each of the three
se
49
50 themes identified can separately be matched with conceptualizations described in earlier
51
d
52
53 studies, but no coherent typology of these conceptualizations has yet been offered.
Le
54
55 In accordance with our findings of the two subthemes ‘entrance requirements’ and
56
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58 ‘early academic success’, which are embedded within the theme of Program Requirements,
59
60 Barrie (2006) describes precursor skills (skills that are the basics or even a prerequisite for
ing
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2
3 university entry) and complement skills (skills that help round out students’ disciplinary
4
5
er
6 learning). The former corresponds to the subtheme of ‘entrance requirements’ and the
7
8 latter to ‘early academic success’. However, the subtheme of ‘course outcome’ is not found
Ed
9
10
11 in Barrie’s framework. In contrast, Barrie describes two types of transferable skills that we
12
u
13 did not detect in our analysis. These are translation skills (skills essential in applying
ca
14
15
16 disciplinary knowledge in non-disciplinary settings) and enabling skills (skills that facilitate
tio
17
18 scholarly abilities of transposing university experiences into original creations of thoughts
19
20
and, ideally, contribution to society). Translation skills and enabling skills seem to
n,
21
22
23 correspond to David Bridges’ (1993) definition of transferring skills: “These are as it were
Sk
24
25 the meta-skills, the second order skills which enable one to select, adapt, adjust and apply
26
ills
27
28 one's other skills to different situations, across different social contexts" (Bridges, 1993: 50).
29
30 In contrast, Bridges (1993) defines transferable skills as skills that can be deployed with little
31
an
32
33 or no adaptation in a variety of social settings (Bridges, 1993: 50). The social settings
34
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35 identified in our review were either higher education contexts (theme 1), employment
36
37
38
contexts (theme 2), or life in general (theme 3).
39
or
40 Consistent with previous frameworks (e.g., Suleman, 2018; Barbosa, 2017), this
41
42
review confirms that transferable skills are associated with development of skills for
k-
43
44
45 employment, either general skills required for various jobs or skills required for specific jobs.
Ba
46
47 Our theme of Employability therefore matches previously described frameworks of
48
se
49
50 transferable skills. In addition, the distinction between discipline-specific skills and generic
51
d
52 transferable skills in terms of employability also emerges in some of the leading conceptual
53
Le
54
55 frameworks of employability as a concept in higher education research (Römgens et al.,
56
arn
57 2019).
58
59
60
ing
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2
3 Consistent with previous studies, this review confirms that the concept of
4
5
er
6 transferable skills is associated with holistic development in relation to whole-person
7
8 development (Chan et al., 2017). Thus, this context of application has previously been
Ed
9
10
11 proposed in relation to the concept of transferable skills (Chan & Fong, 2018).
12
u
13 The Three Themes in a Transfer Theoretical Perspective
ca
14
15 Comparison of the present findings with those of other studies confirms that
16
tio
17
transferable skills are conceptualized as having an inherent directedness of application to
18
19
20 novel and different contexts (Nägele & Stalder, 2017; Barbosa et al., 2017). A possible
n,
21
22 explanation for this may be that the notion of transferable skills is used in the literature as a
23
Sk
24
25 way of emphasizing the assumed transferability of the embedded specific skills. The three
26
ills
27 themes we identified demonstrate the various contexts in which it is anticipated that

28
29
30 transferable skills are applied. Surprisingly, the learning context was not necessarily
31
an
32 regarded as higher education, as noted in the result section.

33
34
In the introduction section, we outlined the view on context (near transfer vs. far
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35
36
37 transfer) articulated by Barnett & Ceci (2002) according to which near transfer refers to the
38
39 close similarity between the context in which knowledge and skills are acquired and in
or
40
41
42 which they are used. Far transfer, on the other hand, is characterized by the use of
k-
43
44 knowledge or skills across contexts with few identical elements (Barnett and Ceci, 2002). In
45
Ba
46
47 this transfer theoretical perspective (near transfer vs. far transfer), our themes appear to be
48
se
49 multidimensional as the studies from which the themes derive vary in their view on what
50
51
d
52 constitutes the learning context and the application contexts.

53
Le
54 The subthemes in the theme Program Requirements (theme 1) cannot easily be

55
56
categorized on the continuum of transfer distance (i.e. near vs. far transfer). The subtheme
arn
57
58
59 ‘early academic success’ contains studies describing the learning context of transferable
60
ing
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2
3 skills, like the university itself (i.e. near transfer), or prior skills developed before entering
4
5
er
6 higher education, which then are expected to be transferred and refined in higher education
7
8 (i.e. far transfer). The studies forming the subtheme of ‘entrance requirement’ contextualize
Ed
9
10
11 a non-university context as the context in which transferable skills are developed.
12
u
13 Moreover, selection of applicants implies selection of applicants’ prior skills, which are
ca
14
15
16 assumed to be transferred into the program (i.e. far transfer). The studies constituting the
tio
17
18 subtheme ‘course outcome’ articulate no specific contexts of application wherefore the
19
20
continuum is unsuitable for this subtheme.
n,
21
22
23 The majority of the studies forming Employability (theme 2) and Holistic
Sk
24
25 Development (theme 3) implicitly or explicitly assume far transfer because higher education
26
ills
27
28 is described as the learning context, and the labor market or life in general is described as
29
30 the application context. These two different contexts were quite dissimilar and remote to
31
an
32
33 one another as they shared only few identical elements. In contrast, the remaining studies
34
dW
35 encompassing these themes (Employability and Holistic Development) implicitly or explicitly

36
37
38
assumed nearer transfer. Thus, simulated settings, work placements, or internships were
39
or
40 described as the learning contexts in which transferable skills were acquired. By using
41
42
learning contexts sharing similarities with the context of application, the distance of transfer
k-
43
44
45 is reduced (Blume, Ford, Baldwin & Huang, 2010). The closer the link between the learning
Ba
46
47 context and the application context, the better are the prospects of stimulating transfer,
48
se
49
50 since it is easier to transfer knowledge and skills between contexts that share similarities
51
d
52 (Grossman & Salas, 2011). Consequently, the acquisition of transferable skills could be
53
Le
54
55 enhanced if the skills are developed in the contexts anticipating their application.
56
arn
57 What Underpins the Development of Transferable Skills?

58
59
60
ing
Hi
1
gh
2
3 Our review echoes previous reviews, substantiating that the educational
4
5
er
6 interventions performed with the EPHPP tool have modest generalizability beyond the
7
8 settings in which they were conducted. For example, Härkänen et al. (2016) conducted a
Ed
9
10
11 systematic review and meta-analysis of educational interventions designed to improve
12
u
13 medication administration skills and safety for registered nurses. Thus, among 14 studies
ca
14
15
16 reviewed, one study was rated as being of strong quality, four studies as being of moderate
tio
17
18 quality, and nine studies as being of weak quality. Similarly, conducting a narrative review of
19
20
nine studies of the effect of aggression training programs for nursing staff and students
n,
21
22
23 working in an acute hospital setting, Heckemann et al. (2015) rated one study as being of
Sk
24
25 strong quality, six studies as being of moderate quality, and two studies as being of weak
26
ills
27
28 quality. In other words, according to the EPHPP criteria, studies of educational interventions
29
30 fall short of achieving high quality, as also concluded in other reviews (e.g., Hersch et al.,
31
an
32
33 2014; Price et al., 2015). Several explanations why studies on educational interventions
34
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35 obtain a lower global quality score may be on the table. In our case, blinding seemed to be a
36
37
38
particular issue as only one study reported on blinding of outcome assessors (Bargouti et al.,
39
or
40 2013) and none on blinding of study participants. This lack of blinding meant that the
41
42
majority of studies could not achieve a higher global rating score than ‘moderate’ because
k-
43
44
45 of the EPHPP scoring system. It is, however, important to bear in mind that although
Ba
46
47 blinding is an important methodological feature (Karanicolas et al., 2010), blinding of
48
se
49
50 outcome assessors and study participants often cannot be done for practical or ethical
51
d
52 reasons in authentic and naturalistic educational settings. If outcome assessors actively

53
Le
54
55 provide or somehow contribute to the educational intervention (Roberts et al., 2005),
56
arn
57 blinding is jeopardized. Blinding of study participants so that they are prevented from
58
59
60
knowing the aim of the educational intervention might also be difficult in some contexts,
ing
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2
3 because students might deduce or obtain information about whether they received the
4
5
er
6 educational intervention or not. In addition, ethical considerations were found to obstruct
7
8 blinding in one instance where researchers collected a written consent in advance of the
Ed
9
10
11 study to ensure good ethical standards and thereby revealed the research questions
12
u
13 (Roberts et al., 2005).
ca
14
15
16 All eight studies conceptualized transferable skills as concerning Employability.
tio
17
18 However, only one study investigated transfer of skills from an educational context to an
19
20
employment context (Mohamed et al., 2017). Thus, in the majority of studies, the outcome
n,
21
22
23 measures appeared misaligned with the conceptual objective of examining transfer of skills
Sk
24
25 to a work context. The studies mainly investigated students’ performance within higher
26
ills
27
28 education and not the extent to which they actually transferred acquired skills to an
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30 employment context (Kaufman & Keller, 1994; Praslova, 2010). For educational strategies
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33 aimed at developing students’ employability skills to be effective, they must be research
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35 based and focused on the transfer of skills acquired in educational contexts to job settings
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(Bewley & O’Neil, 2013).
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40 Limitation of the Present Study

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This review has certain limitations. The fact that a single researcher conducted most
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45 of the study selection and data extraction independently is a limitation that might challenge
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47 the strength of the review. However, we took this limitation into account in several ways.
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50 Firstly, we established a clearly defined set of inclusion criteria through investigator
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52 triangulation (Patton, 2002), which minimized subjectivity in study selection. Secondly, we

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55 randomly selected a sample of 20% of studies for investigator triangulation (Patton, 2002).
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57 Thirdly, it is not required that more researchers locate every available study in a thematic
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analysis because the results of a conceptualization are not based on the exact number of
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3 studies describing the same concept (Thomas & Harden, 2008). This point provides some
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6 reassurance that excluded studies would not fundamentally alter the nature of the themes
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8 identified (Partel et al., 2017). Thus, we conceptualized themes as broad concepts that were
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11 repeated across the data set.
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13 Finally, analyzing and presenting the results of the thematic analysis were
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16 challenging tasks. We applied the reflexive thematic analysis described by Braun & Clark
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18 (2006; 2019) in the analysis and conceptualization of the themes. Hence, the themes are
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quite abstract compared to the explicit content in the studies (Braun & Clark, 2019). The
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23 reliability of the reflexive thematic analysis might therefore be contested since the
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25 development of themes depends on the reviewer’s judgment and insight (Thomas &
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28 Harden, 2008). We tackled this challenge by developing themes in an iterative process
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30 between two researchers and by securing transparency via displaying what led to the
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33 developed themes. Consequently, the readers have the opportunity to judge for themselves
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35 whether our themes capture the key components of transferable skills as a concept in the
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health science literature.
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42
CONCLUSION AND PERSPECTIVES
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45 This review, the first of its kind, aimed to examine conceptualizations of transferable
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47 skills and interventions that may underpin their development in health science education.
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50 Within health sciences education, the literature on transferable skills were concentrated in
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52 healthcare and health professionals’ education, especially medicine and nursing. While the
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55 conceptualizations of transferable skills differ considerably in the broader literature, the
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57 results show that in health science education transferable skills reflected three main
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3 Consequently, this review has implications for health sciences education because
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6 transferable skills are important for the future healthcare workforce to be able to adapt to
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8 ever changing circumstances of practice. In this regard, our findings provide an
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11 understanding of transferable skills contributing to creating a basis for curriculum
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13 development and empirical research on how to develop and assess transferable skills in
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16 future healthcare workers. According to Green et al., (2009), conceptual clarity is important
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18 for the teaching of transferable skills because well-defined learning objectives provide 1)
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educators with a clear purpose to focus their teaching efforts; 2) direct educators’ choice of
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23 relevant teaching strategies; and 3) guide educators’ assessment strategies. The three
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25 identified themes therefore provide a conceptual foundation for aligning teaching and
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28 assessment strategies with intended learning objectives in transferable skills curricula.
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30 The review has also implications for future research. We found that the global
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33 methodological quality of the empirical studies in this review was sparse and weak. Current
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35 literature therefore does not support specific educational interventions for transferable
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skills development among undergraduate students. Future empirical effect studies on
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40 transferrable skills of a higher methodological quality are therefore needed. However,

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sufficient conceptual precision is of paramount importance regardless of methodological
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45 quality because its absence severely threatens the validity of empirical research. In addition,
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47 lack of conceptual precision has practical implications for teaching, learning, and assessment
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50 in higher education. Hence, it is important to be aware of the transfer theoretical
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52 perspective, that is the relation between the learning context and the application context
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55 (near transfer vs. far transfer), when using the notion of transferable skills and other related
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57 terms in empirical studies. The three themes identified in our study are the first step in
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clarifying what the concept of transferable skills actually implies in current research in
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3 health science education. Conceptual clarity is crucial for the validly of future empirical
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6 studies investigating students’ development of transferable skills, not just in health sciences
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8 education but also in higher education generally. We therefore invite future research to
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11 draw on our conceptualization of transferable skills as a point of departure for 1)
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13 investigations of how and when the concept is applied, and for 2) empirical research on how
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16 to develop and assess transferable skills in order to afford students the opportunity to adapt
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18 to future change – in higher education and in the labor marked – in a flexible and
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competent way.
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23
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24 Declarations of interest: This research did not receive any specific grant from funding
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26
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3 LIST OF FIGURES, TABLES, AND APPENDIX
4
5
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6 Figure 1:
7 Flowchart of search and selection strategy
8
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9
Figure 2:
10
11 Search terms by year (n = 152)
12
u
13 Table 1:
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14 Results of authors’ thematic analysis of themes and subthemes derived from the thematic analysis
15
of included articles
16
tio
17
18 Table 2:
19 Characteristics of included quantitative effect studies (n = 8)
20
n,
21
22 Table 3:
23 Quality assessment of the included quantitative effect studies according to the EPHPP tool (n
Sk
24 = 8)
25
26
Appendix:
ills
27
28 List of 152 included articles for thematic analysis referring to table 1
29
30
31
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32
33
34
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35
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3 Figure 1
4
Flowchart of search and selection strategy
5
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7
8
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9
10
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12
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3 Figure 2
4
5 Search terms by year (n = 152)
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6
7
8 14
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9 13
10 12
11 11
Number of studies
12 10
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13 9
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14 8
15 7
16 6
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17 5
18 4
19 3
20 2
n,
21 1
22 0
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
23
Sk
24 Generic Transferable
25 Soft Graduate
26 Core Personal
ills
27 Key Future
28 Employability 21st centery
29 Umbrella terms in combination
30
31
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34
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35
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3 Table 1
4
Results of authors’ thematic analysis of themes and subthemes derived from the thematic analysis
5
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6 of included articles*
7
8
Ed
9 THEMES SUBTHEMES REFERENCE NUMBER (n) (N)
10
11 ACCORDING TO APPENDIX*
12
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13 Program 45
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14
15 Requirements
16
Entrance requirements 1-7 7
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17
18
19
Early academic success 7-20 14
20 Course outcome 3, 12-14, 21-42 24
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23
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24 Future professional work 1, 7, 10, 15, 17, 26, 27, 36, 41- 74
25
26 107
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28 Future work 3, 11, 13, 14, 16, 22, 24, 29, 31- 50
29
30 33, 35, 53, 108-144
31
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32
Holistic 7, 14, 15, 17, 24, 37, 89, 108, 114, 12
33 Development 127, 138, 145
34
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36
37 categorizable
38
39 papers
or
40
41 Note. See the appendix for listed references
42
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3 Table 2
4
Characteristics of included quantitative effect studies (n = 8)
5
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6
Author(s) Subtheme Study aim Study Participants Outcome Confound Analysis Findings
7 identified design examined ers
8 Year by us controlled
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9
Country
10
11 Mohame Future To evaluate Observation 340 final- Interpersonal Partly: Chi- No cohort
12 d et al. professio the impact of al. Two year dentist competency gender, squared differences
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2017 assessment comparison: patients in a and Fisher’s interpersona
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15 Malaysia on students’ intervention 53 with a al level. competency
16 interpersona cohort was survey. were found.
l assessed on ncomparions=18
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17 7).
competency. soft skills;
18 the
19 comparison
20 cohort was
n,
21 not.
22 Mylopoul Future To compare Experiment 51 pre- Preparation All Independe Participants
23 os & work the relative al. clerkship for future nt- sample in basic
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24 Woods impacts of Participants medical learning was t-test. science

25 basic science were students. examined learning
2014 instruction randomly with a test group scored
26 and clinically assigned to (PFLA) which significantly
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27 Canada focused basic required higher in the

28 instruction science participants assessment
29 on instruction to diagnose of
30 performance or clinically 16 patient preparation
on focused cases based for future
31
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Preparation instruction. on novel learning

32 for Future disease (PFLA).
33 learning conditions.
34 Assessment
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(PFLA).
35
36 Barghouti Future To evaluate Observation 54 fifth-year Evidence- All Paired t- Participants
37 et al. work the effect of al. Cohort medical based test in the EBM
38 a short study (One students. medicine course
2013 course in group pre + was significantly
39
evidence- posttest). examined improve
or
40 Jordan based with a test knowledge

41 medicine (Fresno) and skills in
42 (EBM) on which EBM.
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development three steps
44 of of EBM (Ask,
45
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knowledge Acquire,
46 and skills in Appraise).
47 EBM.
48
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Humphris Future To Observation 383 first- Communicati None Exploratory Knowledge

49 professio determine al. Cohort year medical on skills were factor of
50 2002 nal work the influence study (One students examined by analysis communicati
51 of group pre + followed for performance and on skills has
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UK knowledge posttest). 17 months. in objective structural a small but

52
on structured equation significant
53 communicati clinical analysis influence on
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54 on skills over examinations performance

55 time. in OSCE.
56 (OSCE).
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57 Mughal Future To evaluate Observation 210 first-, CPS was None T-test and Participants
58 et al. professio the impact al. second-, examined by ANOVA developed
59 nal work of problem Analytical and third- the social skills
2018 based cross- year medical ‘Collaborativ to a greater
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5 collaborative design. framework’ skills through
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6 solving skills of two
7 (CPS). dimensions
8 (I) social skills
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9 (II) cognitive
skills.
10
11 Murdoch- Future To evaluate Observation 254 third- Self- None Wilcoxon- No
12
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Eaton professio the al. year medical evaluation Test significant
13 nal work educational Analytical students. was differences
2002 contribution cross- examined by between
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14
of self- sectional comparing students’
15 UK assessment study supervisors’ self-
16 during design. and evaluations
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17 individual students’ and
18 students assessments supervisors’
projects. of students’ ratings of
19
individual individual
20 projects. projects.
n,
21
22 Prichard Future To Experiment 295 second- Team-skill Partly: ANCOVA Team-skills
23 et al. work & investigate if al. Two year training was Gender, training
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early team-skills group psychology examined by age and enhance

24 2006 academic training comparison: students. student team collaborative
25 success enhance the The (nintervention=1 group marks experience learning
26 performance intervention 13 and key-skill s group
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27 of cohort ncontrol=94). ratings. performance

collaborative received , but these
28
groups team-skills benefits may
29 through the training, the be lost if
30 introduction control training
31
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of a team cohort did groups are

32 development not. disrupted.
program.
33
34 Roberts Future To compare Experiment 83 first- Ethical All MANOVA Participants
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35 et al. work the relative al. second- evaluation in the

36 impacts of a Participants third- and skills were criteria-
2005 criteria- were fourth-year examined by focused
37
based randomly medical a written intervention
38 method and assigned to students. posttest of group scored
39 a clinical- the (nintervention=2 ability to significantly
or
40 research- intervention 8 ncomparison detect higher in the

41 experience- , =28 ethical assessment
based comparison, ncontrol=27) problems in of enhanced
42
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method on or the hypothetical ethical

43 the control protocol evaluation
44 performance group. vignettes. skills.
45 of discerning
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46
problems in
47 human
48 clinical
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49 research
50 studies.
51
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52
53
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54
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56
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59
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Hi
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3 Table 3
4
5 Quality assessment of the included quantitative effect studies according to the EPHPP tool
er
6
7 (n = 8)
8
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9
Author Selection Study Cofounders Blinding Data collection Withdrawals and Global rating
10
11 Year bias design method drop-outs for paper
12
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13 Mohamed et al. 1 2 3 3 3 1 3
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14
2017
15
16 Mylopaulus & 3 1 1 3 3 3 3
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17 Wood, 2014
18 Barghouti et al. 3 2 1 2 2 3 3
19 2013
20
n,
21 Humpris 1 2 3 3 1 1 3
22 2002
23 Mughal et al. 2018 3 3 3 3 3 1 3
Sk
24
Murdoch-Eaton 3 3 3 3 3 3 3
25
2002
26
ills
27 Prichard et al. 3 2 3 3 3 3 3
28 2006
29 Robers et al. 2005 3 1 1 3 3 1 3
30
31 Note: Abbreviations: 1 = strong; 2 = moderate; 3 = weak.
an
32
33
34
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35
36
37
38
39
or
40
41
42
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44
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59
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Hi
1
gh
2
3 Appendix
4
5 List of 152 included articles for thematic analysis referring to table 1
er
6
7 1. Collins, J., & White, G. (1993). Selection of Auckland medical students over 25 years: a time
8 for change? Medical Education, 27(4), 321-327.
Ed
9 2. Elliott, S., & Epstein, J. (2005). Selecting the future doctors: the role of graduate medical
10 programmes. Internal medicine journal, 35(3), 174-177.
11
12 3. Emerson, A., & Williams, G. J. (2012). An Innovative Approach to Encouraging Spiral Learning
u
13 for Third-Year Undergraduates. Psychology Teaching Review, 18(2), 126-133.
ca
14 4. Katz, S., & Vinker, S. (2014). New non-cognitive procedures for medical applicant selection: a
15 qualitative analysis in one school. BMC medical education, 14(1), 237.
16
5. Traynor, M., Galanouli, D., Roberts, M., Leonard, L., & Gale, T. (2017). Identifying applicants
tio
17
18 suitable to a career in nursing: a value-based approach to undergraduate selection. Journal
19 of Advanced Nursing, 73(6), 1443-1454.
20 6. Tutton, P. (1993). Medical school entrants: semi-structured interview ratings, prior
n,
21 scholastic achievement and personality profiles. Medical Education, 27(4), 328-336.

22
23 7. Chan, C. W., Leung, D. Y., Lee, D. T., Chair, S. Y., Ip, W. Y., & Sit, J. W. (2016). The Perception
Sk
24 of Generic Capabilities and Learning Environment among Undergraduate Nursing Students

25 after the Implementation of a Senior Intake Scheme. Journal of Further and Higher
26 Education, 42(2), 158-165.
ills
27 8. Abraham, R. R., Fisher, M., Kamath, A., Izzati, T. A., Nabila, S., & Atikah, N. N. (2011).
28 Exploring first-year undergraduate medical students' self-directed learning readiness to
29 physiology. Advances in physiology education, 35(4), 393-395.
30
31 9. dos Santos Boni, R. A., Paiva, C. E., de Oliveira, M. A., Lucchetti, G., Fregnani, J. H. T. G., &
an
32 Paiva, B. S. R. (2018). Burnout among medical students during the first years of
33 undergraduate school: Prevalence and associated factors. PloS one, 13(3), e0191746.
34 10. Jünger, J., Schultz, J.-H., Schönemann, J., Wagener, S., Drude, N., Duelli, R., & Resch, F.
dW
35 (2009). AMEE Guide supplements: Peer-assisted learning: A planning and implementation

36 framework. Guide supplement 30.6–practical application. Medical Teacher, 31(1), 55-56.
37
38 11. Kridiotis, C.-A., & Swart, S. (2017). A learning development module to support academically
39 unsuccessful 1st-year medical students. African Journal of Health Professions Education,
or
40 9(2), 62-66.
41 12. Mclachlan, J. C. (2000). Case Study 4: Criterion-based assessment of transferable skills–
42 information retrieval and analysis. Medical Education, 34, 73-74.
k-
43
44 13. McLean, M., Shaban, S., & Murdoch-Eaton, D. (2011). Transferable skills of incoming medical
45 students and their development over the first academic year: The United Arab Emirates
Ba
46 experience. Medical Teacher, 33(6), e297-e305.

47 14. McNeil, H. P., Scicluna, H. A., Boyle, P., Grimm, M. C., Gibson, K. A., & Jones, P. D. (2012).
48 Successful development of generic capabilities in an undergraduate medical education
se
49 program. Higher Education Research & Development, 31(4), 525-539.

50
51 15. Murdoch-Eaton, D., & Whittle, S. (2012). Generic skills in medical education: developing the
d
52 tools for successful lifelong learning. Medical Education, 46(1), 120-128.

53 16. Prichard, J. S., Bizo, L. A., & Stratford, R. J. (2006). The educational impact of team-skills
Le
54 training: Preparing students to work in groups. British Journal of Educational Psychology,

55 76(1), 119-140.
56
17. Redmond, C., Davies, C., Halligan, P., Joye, R., Carroll, L., & Frawley, T. (2018). Nursing and
arn
57
58 midwifery students' perception of learning enablers and gains in the first semester of their
59 BSc programmes: A cross sectional study. Nurse Education Today, 65, 242-249.
60
ing
Hi
1
gh
2
3 18. Whittle, S. R., & Eaton, D. G. M. (2001). Attitudes towards transferable skills in medical
4 undergraduates. Medical Education, 35(2), 148-153.
5
er
6 19. Whittle, S. R., & Murdoch-Eaton, D. G. (2004). Lifelong learning skills: how experienced are
7 students when they enter medical school? Medical Teacher, 26(6), 576-578.
8 20. Whittle, S. R., Pell, G., & Murdoch-Eaton, D. G. (2010). Recent changes to students'
Ed
9 perceptions of their key skills on entry to higher education. Journal of Further and Higher
10 Education, 34(4), 557-570.
11
12 21. Aulakh, A., Tweed, S., Moore, J., & Graham, W. (2017). Integrating global health with
u
13 medical education. The Clinical Teacher, 14(2), 119-123.
ca
14 22. Choudhury, B., & Gouldsborough, I. (2012). The use of electronic media to develop
15 transferable skills in science students studying anatomy. Anatomical sciences education,
16 5(3), 125-131.
tio
17
18 23. Cranney, J., Turnbull, C., Provost, S. C., Martin, F., Katsikitis, M., White, F. A., . . . Morris, S.
19 (2009). Graduate attributes of the 4-year Australian undergraduate psychology program.
20 Australian Psychologist, 44(4), 253-262.
n,
21 24. Elander, J. (2004). A Discipline-Based Undergraduate Skills Module. Psychology Learning &
22 Teaching, 3(1), 48-55.
23
25. Gimenez, J. (2012). Disciplinary epistemologies, generic attributes and undergraduate
Sk
24
25 academic writing in nursing and midwifery. Higher education, 63(4), 401-419.
26 26. Goedeke, S., & Gibson, K. (2011). What do new psychology students know about
ills
27 psychology? Australian Psychologist, 46(2), 133-139.

28
29 27. Jha, V., Duffy, S., & Murdoch-Eaton, D. (2002). Development of transferable skills during
30 short special study modules: students' self-appraisal. Medical Teacher, 24(2), 202-204.
31
an
28. Jones, M., Singh, S., & Meakin, R. (2008). Undergraduate research in primary care: is it
32 sustainable? Primary Health Care Research & Development, 9(1), 85-95.
33
34 29. Kennedy, B., & Innes, M. (2005). The teaching of psychology in the contemporary university:
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35 Beyond the accreditation guidelines. Australian Psychologist, 40(3), 159-169.

36 30. Kershaw, T. C., Lippman, J. P., & Fugate, J. M. (2018). Practice makes proficient: teaching
37 undergraduate students to understand published research. Instructional Science, 46(6), 921-
38 946.
39
31. McGarr, O., & Clifford, A. M. (2013). ‘Just enough to make you take it seriously’: exploring
or
40
41 students’ attitudes towards peer assessment. Higher education, 65(6), 677-693.
42 32. Mubuuke, A. G., Louw, A. J., & Van Schalkwyk, S. (2016). Utilizing students’ experiences and
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43 opinions of feedback during problem based learning tutorials to develop a facilitator

44 feedback guide: an exploratory qualitative study. BMC medical education, 16(1), 6.
45
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46 33. O'Hare, L., & McGuinness, C. (2005). Skills and attributes developed by psychology
47 undergraduates: ratings by undergraduates, postgraduates, academic psychologists and
48 professional practitioners. Psychology Learning & Teaching, 4(1), 35-42.
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49 34. Razzaq, Z., & Ahsin, S. (2011). PBL wrap up sessions: An approach to enhance generic skills in
50 medical students. Journal of Ayub Medical College Abbottabad, 23(2), 162-165.
51
d
52 35. Robley, W., Whittle, S., & Murdoch-Eaton, D. (2005). Mapping generic skills curricula: a
53 recommended methodology. Journal of Further and Higher Education, 29(3), 221-231.
Le
54 36. Rosenkranz, P., Fielden, A., & Tzemou, E. (2014). Teaching Psychological Research Methods
55 through a Pragmatic and Programmatic Approach. Psychology Teaching Review, 20(2), 28-
56 35.
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58 37. Rowe, M. (2016). Developing graduate attributes in an open online course. British Journal of
59 Educational Technology, 47(5), 873-882.
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2
3 38. Seneviratne, R., Samarasekera, D., Karunathilake, I., & Ponnamperuma, G. (2001). Students'
4 perception of problem-based learning in the medical curriculum of the Faculty of Medicine,
5 University of Colombo. Annals of the Academy of Medicine, Singapore, 30(4), 379-381.
er
6
7 39. Tucker, B., Jones, S., & Straker, L. (2008). Online student evaluation improves Course
8 Experience Questionnaire results in a physiotherapy program. Higher Education Research &
Development, 27(3), 281-296.
Ed
9
10 40. Vahed, A., & Cruickshank, G. (2018). Integrating academic support to develop undergraduate
11 research in Dental Technology: A case study in a South African University of Technology.
12
u
Innovations in Education and Teaching International, 55(5), 566-574.
13
41. Wright, D., Wickham, J., & Sach, T. (2014). Problem-based learning: an exploration of
ca
14
15 student opinions on its educational role in one UK pharmacy undergraduate curriculum.
16 International Journal of Pharmacy Practice, 22(3), 223-230.
tio
17 42. Zabalegui, A., Macia, L., Márquez, J., Ricomá, R., Nuin, C., Mariscal, I., . . . Moncho, J. (2006).
18 Changes in nursing education in the European Union. Journal of Nursing Scholarship, 38(2),
19 114-118.
20
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21 43. Ahmad, M., Goodsman, D., & Lightbody, E. (2012). Introducing medical students to
22 prehospital care. The Clinical Teacher, 9(3), 168-172.
23 44. Allinson, M. D., & Black, P. (2018). Students views of an online ethical decision-support tool.
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24 Currents in Pharmacy Teaching and Learning, 10(2), 226-230.

25
26 45. Baldwin, A., Bentley, K., Langtree, T., & Mills, J. (2014). Achieving graduate outcomes in
undergraduate nursing education: following the Yellow Brick Road. Nurse education in
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27
28 practice, 14(1), 9-11.
29 46. Bellack, J. P., Morjikian, R., Barger, S., Strachota, E., Fitzmaurice, J., Lee, A., . . . O'Neil, E. H.
30 (2001). Developing BSN leaders for the future: the Fuld Leadership Initiative for Nursing
31
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32
33 47. Bergh, A.-M., Van Staden, C., Joubert, P. M., Krüger, C., Pickworth, G. E., Roos, J. L., . . .
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39
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47 administrators and educators. Journal of Advanced Nursing, 24(6), 1224-1233.
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22 62. Ghias, K., Lakho, G. R., Asim, H., Azam, I. S., & Saeed, S. A. (2014). Self-reported attitudes and
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University of Southern Denmark

What do we mean by “transferable skills”? A literature review of how the concept is

Olesen, Kristoffer Brix; Christensen, Mette Krogh; O'Neill, Lotte Dyhrberg

Citation for pulished version (APA):

Go to publication entry in University of Southern Denmark's Research Portal

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Download date: 16. Oct. 2023

WHAT DO WE MEAN BY ‘TRANSFERABLE SKILLS’? A

CONCEPTUALIZED IN UNDERGRADUATE HEALTH SCIENCES

Journal: Higher Education, Skills and Work-Based Learning

Manuscript Type: Literature Review

health science education, higher education, literature review, transfer,

16 Dear Editor, dear reviewers,

50 a literature review by its very nature has a

16 misunderstood. In order to clarify what we

19 have added an explanation in the introduction

26 Advances in Health Sciences Education.

33 dominance of healthcare and health

42 explanation of the purpose and the relevance

46 page 5, yellow text).

50 requires clarification. I think this could be

26 sciences education above, in the introduction

29 I think if the health sciences vs healthcare

33 (page 9, before “Emerging Themes”, see

23 society: detailed description of the term health

26 and in the “Purpose of the Present Study”

42 order to address the relevance of our study to

50 technical language of the field and the expected

23 and concentrated in healthcare and health

out of this is health sciences or health care

42 provide details if possible.: I am thinking yes.

50 perspectives and the conclusions we have

23 where there is no precise and comprehensive

42 Bologna Declaration (1999) sought to bring

across Europe. However, the Declaration was

49 2008. Since most of the studies were published

35 qualitative, and mixed-methods studies. A seven-stage sequential exploratory synthesis of

52 need for a overview of the literature on transferable skills to r support students’

57 outlines a typology of how transferable skills are conceptualized and empirically

40 While transferable skills is a rather ambiguously defined notion, it is commonly used

57 Purpose of the Present Study

40 business, engineering). We therefore pose the following questions:

35 popular as it provides a rich understanding of complex phenomena. Based on the two

40 Stage 2: Eligibility Criteria

52 or title; (d) examining undergraduate or pre-graduate educations in health sciences (more

32 Please insert Figure 2 here

52 Examination of the range of conceptualizations within the included studies testifies

54 to the absence of a widely accepted definition of transferable skills. Therefore, we could

52 information literacy, problem-solving, written and verbal communication) occurred equally

57 solving) could be conceptualized as being transferable both to an Employability context

35 Quantitative Effect Studies

27 themes we identified demonstrate the various contexts in which it is anticipated that

32 regarded as higher education, as noted in the result section.

52 constitutes the learning context and the application contexts.

54 The subthemes in the theme Program Requirements (theme 1) cannot easily be

35 encompassing these themes (Employability and Holistic Development) implicitly or explicitly

57 What Underpins the Development of Transferable Skills?

52 reasons in authentic and naturalistic educational settings. If outcome assessors actively

40 Limitation of the Present Study

52 triangulation (Patton, 2002), which minimized subjectivity in study selection. Secondly, we

40 transferrable skills of a higher methodological quality are therefore needed. However,

49 Journal of Health Policy and Management, Vol. 7 No. 6, pp. 491-503.