A Scoping Review and Realist Synthesis of Surgical Trainees' Perspectives in Competency-based Training

Area of Science:

• Medical Education
• Surgical Training
• Competency-Based Medical Education (CBME)

Background:

• Competency-based medical education (CBME) is widely adopted in global surgical training.
• Mixed findings exist regarding CBME's impact on trainee wellness.
• Program directors need evidence-based strategies for effective CBME implementation.

Purpose of the Study:

• To review literature on surgical trainees' experiences with competency-based medical education (CBME).
• To identify strengths and weaknesses of CBME in surgical training.
• To map essential activities for successful CBME implementation.

Main Methods:

• A scoping literature review was conducted from 2012 to 2024, searching multiple databases and grey literature.
• Studies reporting surgical trainees' perceptions of CBME advantages and disadvantages were included.
• Data synthesis used reflexive thematic analysis and a scientific realism perspective.

Main Results:

• Analysis of 227 articles revealed four key themes: implementation logistics, educational value, infectious apathy, and psychological implications.
• Program theories were proposed, mapping themes to understand discrepancies between intended and actual CBME impact.
• The review identified specific advantages and disadvantages of CBME from trainee perspectives.

Conclusions:

• Mapping themes and program theories offers guidance for refining CBME implementation in surgical programs.
• These refinements aim to improve resident well-being.
• The ultimate goal is to foster the development of safe and competent surgeons.