Lost in translation? How context shapes the implementation of Competence by Design in operative settings

Given the complexity of the transition to competency-based medical education (CBME) and the diversity of systems and learning contexts, the literature has acknowledged the need for principled yet contextual approaches to implementation. There is a need for research that examines these adaptations and their consequences, both intended and unintended.

We performed a constructivist grounded theory study to explore how the theory of CBME translated to practice in operative settings in a Canadian approach to CBME: Competence by Design (CBD).

Program contexts both enabled and hindered how CBD translated into practice. The operative context was aligned with the principles of competency-focused instruction and allowed for frequent, direct observation and formative feedback. Time, personnel, and technology constraints unique to the patterns of practice in operative settings hindered programmatic assessment.

Adaptations to CBME that are responsive to the context of programs can support the intended conceptual learning conditions of CBME.