Learning in practiceCompetency based medical training: reviewCommentary: The baby is thrown out with the bathwater
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7366.693 (Published 28 September 2002) Cite this as: BMJ 2002;325:693
Competency based medical training: review
- Wai-Ching Leung (wai_chingleung@hotmail.com), honorary lecturer in public health medicine.
- Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
- The Education Centre, Birmingham Children's Hospital, Birmingham B4 6NH
- Accepted 23 May 2002
The competency approach has become prominent at most stages of undergraduate and postgraduate medical training in many countries. In the United Kingdom, for example, it forms part of the performance procedures of the General Medical Council (GMC),1 underpins objectively structured clinical examinations (OSCEs) and records of in-training assessment (RITA), and has been advocated for the selection of registrars in general practice and interviews. 2 3 It has become central to the professional lives of all doctors and is treated as if it were a panacea—but there is little consensus among trainees, trainers, and committees on what this approach entails.
I aim to explore the origins and development of the competency approach, evaluate its current role in medical training, and discuss its strengths and limitations.
Summary points
The competency based approach consists of functional analysis of occupational roles, translation of these roles into outcomes, and assessment of trainees' progress on the basis of their demonstrated performance of these outcomes
It has become dominant at most stages of medical training
Potential advantages include individualised flexible training, transparent standards, and increased public accountability
If applied inappropriately, it can result in demotivation, a focus on minimum acceptable standards, increased administrative burden and a reduction in the educational content
We should be cautious of applying the competency based approach universally unless robustly defined higher order competencies are available
The birth of the competency movement
The competency approach did not result directly from recent scandals of incompetent doctors. It originated from parallel developments in vocational training in many countries, such as the national qualifications framework in New Zealand, the national training board in Australia, the national skills standards initiative in the United States, and the national vocational qualifications (NVQs) in the United Kingdom.4 This movement was driven largely by the political perceived need to make the national workforce more competitive in the …