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Development and Delphi validation of WONCA-aligned competency-based learning outcomes for undergraduate family
Mariana Bento1, Joana Monteiro2, Paulo Santos2,3
1Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Introduction:
Competency-Based Medical Education (CBME) promotes the integration of knowledge, skills, and attitudes through an outcomes-oriented approach. Family Medicine offers an ideal context for its implementation; however, undergraduate training remains heterogeneous and insufficiently aligned with the World Organisation of Family Doctors (WONCA) competency framework. In particular, assessment often remains focused on task completion rather than observable performance in authentic clinical settings. This study aimed to develop and validate WONCA-aligned competency-based learning outcomes for undergraduate Family Medicine to support more explicit and competency-oriented clinical training.
Methods:
A structured multi-phase study combining expert-informed item generation and Delphi-based consensus validation was conducted. In the initial phase, Family Medicine physicians with experience in medical education contributed proposed learning outcomes through an open-ended questionnaire. These were synthesised into preliminary outcomes aligned with the WONCA competencies. A two-round modified Delphi process was then used to evaluate each outcome using a five-point Likert scale. Content validity was assessed using the item-level content validity index (I-CVI), with consensus defined as ≥0.80.
Results:
Twenty-two preliminary learning outcomes were generated. In the first Delphi round (n = 109), 20 outcomes achieved consensus (I-CVI ≥ 0.80). Two outcomes required reformulation and were re-evaluated in a second round (n = 103), after which both reached consensus. The final set comprised 22 validated competency-based learning outcomes aligned with the WONCA framework.
Conclusion:
This study provides a Delphi-validated operationalisation of the WONCA competency framework into observable and developmentally appropriate learning outcomes for undergraduate Family Medicine. These outcomes offer a structured foundation for competency-oriented teaching and assessment, and may inform the future development of portfolio-based approaches in clinical education.
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