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The Implementation of Competency-Based Medical Education in Surgical Training: A Scoping Review
Joon Soo Kim1, Sophie Yu2, Margaret B Mitchell3
1Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Background:
The pace of implementation of competency-based medical education (CBME) in postgraduate surgical training has varied substantially across settings, due in part to inconsistent definitions of what constitutes CBME in practice. Employing the lens of Van Melle et al.'s 2019 codification of the core components of CBME, this scoping review aims to characterize how CBME has been implemented in surgical residency programs worldwide.
Methods:
Embase, PubMed, MedEdPortal, and ERIC were searched for English-language articles describing active CBME implementation in surgical residency programs. A scoping review was conducted using Covidence and reported using the PRISMA-ScR guidelines. Research abstracts, systematic/scoping reviews, and studies describing isolated workshops or training supplements were excluded. CBME implementations extracted from included studies were classified as systemic implementations, local innovations, or competency-based assessment instruments. Given substantial redundancy in the literature, not all studies describing the U.S. Accreditation Council for Graduate Medical Education Core Competencies or Milestones were included; 5 exemplary studies from this corpus were included as representative descriptions. All included studies were evaluated against the 5 CBME core components: outcome competencies, sequenced progression, tailored learning experiences, competency-focused instruction, and programmatic assessment.
Results:
Seventy studies published between 2001 and 2023 were included, predominantly from North America and Europe. Outcome competencies were clearly defined across all systemic implementations; however, sequenced progression, competency-focused instruction, and programmatic assessment were more variably incorporated, and were more often satisfied in Canadian and European frameworks. While local innovations and assessment instruments demonstrated novelty and the feasibility of CBME implementation, alignment with all 5 core components was uncommon.
Conclusions:
CBME implementation in surgical residency remains heterogeneous, with many programs layering components of CBME onto existing curricular structures. These findings suggest that greater emphasis on future systemic educational reform efforts may support more impactful CBME implementation in surgical training programs.
