Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula: A qualitative study.

HUMAN services programs; CURRICULUM planning; CLINICAL competence; CLINICAL medicine; CONCEPTUAL structures; CONTENT analysis; INTERNSHIP programs; INTERVIEWING; RESEARCH methodology; STUDY & teaching of medicine; OBSTETRICS; PEDIATRICS; RESEARCH funding; SCHOOL environment; SOUND recordings; INSTITUTIONAL cooperation; EDUCATIONAL outcomes; ORGANIZATIONAL goals; CLINICAL supervision; DESCRIPTIVE statistics; EDUCATION; PSYCHOLOGY

Background: Postgraduate medical education (PGME) curricula are being redesigned across the western world. Aim: This study examined the implementation process (what works where and why) of new competency-based PGME curricula and relevant factors influencing this process. Methods: In a nationwide project (2006-2010) in the Netherlands, competency-based PGME curricula were implemented for residents in Pediatrics and Obstetrics & Gynecology. The authors conducted 25 semi-structured interviews and used a multi-level theoretical framework to guide coding. Results: The implementation process proved to be highly dynamic, non-linear, and influenced by many factors. These could be divided into attributes of the innovations/adopters, the implementation process, and the organization. The context determined the speed, quality, and direction of the process and how a factor affected the process. Conclusions: We identified specific features of PGME innovation: the challenge of implementing other competencies than that of the medical expert; the importance of regional implementation strategies and educational support; the balance between training and patient care; and the need for regional inter-organizational networks of hospitals. The authors recommend: design the curriculum with the needs of the users in mind; facilitate knowledge sharing; organize educational support; translate the national curriculum to the local workplace; and promote regional inter-organizational networks between hospitals. [ABSTRACT FROM AUTHOR]

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