A response to "competency frameworks: universal or local" by Mortaz Hejri and Jalili (2012).

First, we would like to thank Hejri and Jalili (Hejri and Jalili 2013) for endorsing the main point in our critical review of outcome (competency) based education (Morcke et al. 2012). We agree with the two points they make: that global prescriptions of curriculum content can be insensitive to cultural differences; and that effective curriculum development calls for local engagement. For the record, the phrase they criticise is not one we wrote, but the conclusion of other authors whose work we reviewed. Their point, nevertheless, is important enough to deserve a reaction. It is one thing to say the CanMEDS competency framework has been extensively adopted around the world. It is another thing to say CanMEDS is equally suited to all cultures. What can be said, however, is that it travels well! A framework, which was developed for use in Canada, has been adopted in Denmark as a framework across preand postgraduate training and across all four medical schools, which have different curricula and different approaches to learning. In the Netherlands, likewise, CanMEDS has provided useful as a national organizing framework for competency based postgraduate education. The secret of its success may be that it leaves the scope for local interpretation, which Hejri and Jalili (Hejri and Jalili 2013) ask for. But therein lies a big problem of competency-based education. What is gained in generalizability is lost in specificity. Our review did not conclude that all medical schools around the world should adopt the same framework. To the contrary, we agree with Hejri and Jalili that medical schools ‘‘should evaluate the risks and benefits of developing a new set of outcomes before adopting an existing framework.’’ What we did conclude was that outcome-based