Introducing competency-based postgraduate medical training: gains and losses

Niels Kristian Kjaer,Troels Kodal,Allen F Shaughnessy,Dorte Qvesel

doi:10.5116/ijme.4e78.427f

Abstract

Objectives: The purpose of this study is to explore the gains and losses, from the trainees’ perspective, that occur when replacing process-oriented basic medical training with competency-based training and to explore whether competency-based training can justify a reduction in clinical training.MethodsWe performed a national cross-sectional survey of attitudes of Danish doctors who had completed either the old process-oriented 18-month training period (n=671) or the new competency-based 12-month training period (n=547). A total of 1218 doctors were included and 792 of them completed an online survey, yielding a response rate of 65%.ResultsTrainees of the old process-oriented programme (53%) felt more ready to continue medical training than the doctors (84%) who followed the new and shorter competency-based programme. The differences was statistically significant (t (790) = 11.16; p<0.0001). The latter group did not feel the competency-based programme improved the learning environment. Some trainees reported that learning objectives seem to optimize their learning within defined learning frames. They valued a curriculum that should not only contain learning objectives but that should also ensure relevant learning opportunities, providing sufficient time for learning and useful feedback.ConclusionsIt is unlikely that a competency-based curriculum can justify a significant reduction in the time spent on clinical training. The learning approaches and the amount of time that we dedicate to training are important. Implementation of a new curriculum requires a substantial effort.

Highlights

Outcome-based postgraduate education is an approach in which outcomes for learning are specified in terms of specific performance measures.[1,2,3] It is a learner-centred approach that emphasizes attainment and documentation of performance in practice, called “outcomes.” It takes a constructivist approach and has the potential to decrease the time spent in training.[3]
Traditional, processoriented training (PO) means education steered by defined learning frames and opportunistic learning rather than learning guided by objectives defining competency.[2,4,5]
The purpose of this study was to explore, from the trainees’ perspective, the gains and losses when replacing a process-oriented basic medical training programme with modern competency-based training, and to explore whether competency-based training can justify a reduction in clinical training

Summary

Introduction

Outcome-based postgraduate education is an approach in which outcomes for learning are specified in terms of specific performance measures.[1,2,3] It is a learner-centred approach that emphasizes attainment and documentation of performance in practice, called “outcomes.” It takes a constructivist approach and has the potential to decrease the time spent in training.[3]. In contrast to the previous specific learning objectives, these competencies were general and specified performance-based measures, e.g., “The trainee should be able to perform follow-up consultations and adjust treatment in patients with chronic diseases.”. One aim of this change in structure was to provide more supervision and feedback for trainees to strengthen the focus on outcome-based learning objectives.[9] All trainees have to obtain the same general competencies, but each competency can be adapted to the specific learning situation found in the different departments.

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Conclusion