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Proficiency-based training and evidence-based methodology: a systematic review and meta-analysis.
Ruben De Groote1,2,3, Edoardo Beatrici1,2,4, Maria Peraire Lores1,5
1ORSI Academy, Ghent, Belgium.
BJU International
|June 2, 2026
Summary
Proficiency-based progression (PBP) training adherence to evidence-based criteria significantly improves healthcare trainee performance. Studies meeting more PBP criteria demonstrated superior outcomes in reducing errors and procedural time.
Area of Science:
- Medical Education
- Surgical Training
- Healthcare Professions Education
Background:
- Proficiency-based progression (PBP) is a training model emphasizing skill mastery before advancement.
- Adherence to established PBP criteria in healthcare training requires systematic evaluation.
- Previous studies have not comprehensively assessed PBP methodology adherence and its impact on outcomes.
Purpose of the Study:
- To evaluate the extent to which self-labeled proficiency-based progression (PBP) studies align with evidence-based PBP criteria.
- To investigate the relationship between adherence to PBP criteria and training performance outcomes in healthcare professionals.
Main Methods:
- A systematic review and meta-analysis of prospective studies on healthcare procedural training.
- Searched multiple databases (PubMed, CENTRAL, EMBASE, MEDLINE, Scopus) up to March 2023.
- Extracted data on adherence to 18 PBP criteria and objective performance metrics; pooled effect sizes using random-effects models.
Main Results:
- 175 studies met inclusion criteria; 18 were PBP studies.
- PBP studies demonstrated higher adherence (94%) to minimum PBP criteria compared to non-PBP studies (36%).
- PBP training significantly reduced errors (58%) and time (28%), and increased steps performed (22%); greater adherence correlated with better performance.
Conclusions:
- Training methodologies that more closely adhere to established PBP criteria yield superior trainee performance outcomes.
- Implementing and adhering to comprehensive PBP criteria is crucial for optimizing healthcare training effectiveness.