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

Med Teach. 2012;34(8):e589-602. doi: 10.3109/0142159X.2012.670325. Epub 2012 Apr 10.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Competency-Based Education*
  • Diffusion of Innovation*
  • Education, Medical, Graduate / methods*
  • Gynecology / education
  • Humans
  • Netherlands
  • Obstetrics / education
  • Pediatrics / education
  • Qualitative Research