This paper seeks to explore the issue of managerial competencies within the context of clinical performance. The paper outlines the manner in which competencies are identified, measured and evaluated within a clinical setting. A particular focus deals with those issues that underpin the creation of adverse events within a clinical setting, although matters relevant to public health are also discussed. The paper explores the nature of individual, group and organisational learning and considers its implications for management development and competency testing. The paper concludes by making recommendations concerning the manner in which university education can be adapted and developed and the processes of competency management changed in order to address some of the issues that are raised within the paper.