Introducing competency-based postgraduate medical training: gains and losses

Niels Kristian Kjaer1, Troels Kodal1, Allen F. Shaughnessy2 and Dorte Qvesel3

1Postgraduate Education, Medical Faculty, University of Southern Denmark, Denmark

2Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.

3Department of Postgraduate Medical Education, Southern Denmark, Denmark

Submitted: 12/07/2011; Accepted: 20/09/2011; Published: 03/10/2011

Int J Med Educ. 2011; 2:110-115; doi: 10.5116/ijme.4e78.427f

© 2011 Niels Kristian Kjaer et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use of work provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0

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.

Methods: We 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%.

Results: Trainees 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[sub](790)[/sub] = 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.

Conclusions: It 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.