Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula: A qualitative study

• Published in: Medical teacher Vol. 34; no. 8; pp. e589 - e602
• Main Authors: Jippes, E., Van Luijk, S.J., Pols, J., Achterkamp, M.C., Brand, P.L.P., Van Engelen, J.M.L.
• Format: Journal Article
• Language: English
• Published: England Informa UK, Ltd 01.08.2012; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Clinical competence; Coding; Competence; Competency-Based Education; Curricula; Curriculum; Diffusion of Innovation; Education, Medical, Graduate - methods; Educational Finance; Graduate students; Graduate studies; Graduates; Gynecology; Gynecology - education; Hospitals; Humans; Innovations; Interviews; Medical Education; Medicine; National Curriculum; Netherlands; Obstetrics - education; Paediatrics; Patient care; Pediatrics - education; Qualitative Research; Semi Structured Interviews; Training; Workplaces; Netherlands
• ISSN: 0142-159X; 1466-187X
• DOI: 10.3109/0142159X.2012.670325

Background: Postgraduate medical education (PGME) curricula are being redesigned across the western world. Aim: This study examined the implementation process (what works where and why) of new competency-based PGME curricula and relevant factors influencing this process. Methods: In a nationwide project (2006-2010) in the Netherlands, competency-based PGME curricula were implemented for residents in Pediatrics and Obstetrics & Gynecology. The authors conducted 25 semi-structured interviews and used a multi-level theoretical framework to guide coding. Results: The implementation process proved to be highly dynamic, non-linear, and influenced by many factors. These could be divided into attributes of the innovations/adopters, the implementation process, and the organization. The context determined the speed, quality, and direction of the process and how a factor affected the process. Conclusions: We identified specific features of PGME innovation: the challenge of implementing other competencies than that of the medical expert; the importance of regional implementation strategies and educational support; the balance between training and patient care; and the need for regional inter-organizational networks of hospitals. The authors recommend: design the curriculum with the needs of the users in mind; facilitate knowledge sharing; organize educational support; translate the national curriculum to the local workplace; and promote regional inter-organizational networks between hospitals.