Introducing competency-based postgraduate medical training: gains and losses

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(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. 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.