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Centered on learning, but is it learner centered?: Paediatric resident perspectives on competency-based medical
Harrison Anzinger1, Brett Schrewe2
1Pediatric Resident, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Victoria, Canada.
Medical Education
|November 14, 2025
Summary
Paediatric residents find Competence By Design (CBD) places administrative burdens on them and offers inconsistent feedback, despite agreeing with its goals. Addressing resident critiques is vital for improving competency-based medical education (CBME).
Area of Science:
- Medical Education
- Pediatric Residency Training
- Competency-Based Medical Education
Background:
- Canadian paediatrics residency programs transitioned to Competence By Design (CBD), a learner-centered competency-based medical education (CBME) model.
- Resident input was limited during CBD's development, raising concerns about its practical impact on trainees.
- This study aimed to understand how CBD affects paediatric residents' educational experiences.
Purpose of the Study:
- To explore paediatric residents' perspectives on the implementation of Competence By Design (CBD).
- To identify the effects of CBD on residents' educational experiences in Canadian paediatrics programs.
- To inform improvements to the CBME training model based on resident feedback.
Main Methods:
- Qualitative instrumental single case study design.
- Semi-structured interviews conducted with fourteen paediatric residents in their third year of training.
- Reflexive, inductive thematic analysis used to identify key themes in resident experiences.
Main Results:
- Residents support CBD's aims but report increased administrative burden and responsibility.
- Entrustable Professional Activities (EPAs) provided variable feedback, and CBD was perceived more as assessment of learning than for learning.
- Staff physicians encountered challenges in adopting the CBD framework.
Conclusions:
- Findings indicate potential negative effects of CBD on residents, despite its learner-centered intentions.
- Resident critiques must be addressed to optimize CBME systems.
- Deeper consideration of historical and ideological factors influencing CBME design and delivery is necessary.
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