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Purpose of the study <p>Reports concerning implementation of competency-based postgraduate medical education (CB-PGME) are mostly from high income countries where programs are nationally regulated. The present study evaluates implementation of CB-PGME as an institutional initiative in a low- middle-income country (LMIC) where it is not yet a formal accreditation requirement.</p> Study design <p>An exploratory descriptive qualitative study in mid-2023, eighteen months after initiating transition, used focus group discussions to elicit and analyze program directors’ perceptions of the fidelity of CB-PGME implementation in five selected residency programs of the Aga Khan University (AKU) in Pakistan. Research trustworthiness criteria were duly addressed.</p> Results <p>Three themes emerged as relevant: understanding of and commitment to workplace-based assessment; integration of learning with clinical work; and alignment of institutional policies for effective governance. Early gains included drawing stakeholders’ attention to CB-PGME; effecting changes in curriculum and assessment; reinforcing the importance of the clinical learning environment; and providing governance at program and institution levels. Simultaneously, deficiencies were observed in faculty’s constructive feedback and timely documentation following workplace-based assessment (WPBA); holistic assessment of residents’ competencies; residents’ understanding of WPBA intent; administration of WPBAs in busy or extended service locations; longitudinal continuity of clinical postings; empowerment of program directors; and alignment of institutional policies.</p> Conclusion <p>The deficiencies encountered during early implementation of CB-PGME at AKU were like those faced elsewhere and potentially reversible through institutional effort. So, it would be safe to assume that institutional initiatives to implement CB-PGME are feasible in LMIC, while awaiting formal national accreditation.</p>

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Competency-based postgraduate medical education as an institutional initiative in a low- middle-income country: program directors’ perceptions of early implementation

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  • 发表日期：

    2025年7月1日

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  • Qamar Riaz,
  • Muhammad Rizwan Khan,
  • Mushtaq Ahmed

摘要

Purpose of the study

Reports concerning implementation of competency-based postgraduate medical education (CB-PGME) are mostly from high income countries where programs are nationally regulated. The present study evaluates implementation of CB-PGME as an institutional initiative in a low- middle-income country (LMIC) where it is not yet a formal accreditation requirement.

Study design

An exploratory descriptive qualitative study in mid-2023, eighteen months after initiating transition, used focus group discussions to elicit and analyze program directors’ perceptions of the fidelity of CB-PGME implementation in five selected residency programs of the Aga Khan University (AKU) in Pakistan. Research trustworthiness criteria were duly addressed.

Results

Three themes emerged as relevant: understanding of and commitment to workplace-based assessment; integration of learning with clinical work; and alignment of institutional policies for effective governance. Early gains included drawing stakeholders’ attention to CB-PGME; effecting changes in curriculum and assessment; reinforcing the importance of the clinical learning environment; and providing governance at program and institution levels. Simultaneously, deficiencies were observed in faculty’s constructive feedback and timely documentation following workplace-based assessment (WPBA); holistic assessment of residents’ competencies; residents’ understanding of WPBA intent; administration of WPBAs in busy or extended service locations; longitudinal continuity of clinical postings; empowerment of program directors; and alignment of institutional policies.

Conclusion

The deficiencies encountered during early implementation of CB-PGME at AKU were like those faced elsewhere and potentially reversible through institutional effort. So, it would be safe to assume that institutional initiatives to implement CB-PGME are feasible in LMIC, while awaiting formal national accreditation.