# Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education

## TL;DR

This paper introduces a new national model for medical training that focuses on developing specific skills over time, aiming to improve the quality of doctors.

## Contribution

The paper presents a large-scale, time-variable competency-based model for postgraduate medical education called Competence by Design.

## Key findings

- A national, multi-specialty competency-based system was successfully implemented using 14 innovations.
- The model is based on the Van Melle Core Components of competency-based medical education.
- The system's early success offers lessons for global competency-based education initiatives.

## Abstract

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.