Context / probleemstelling of aanleiding

Probleemstelling (inclusief theoretische onderbouwing en onderzoeksvraag/vragen):
Personalization and flexibility are increasingly emphasized in medical education. While competency-based medical education (CBME) is theoretically positioned to support personalization, practical challenges—such as time-fixed rotations, rigid learning outcomes, and assessment burden—often limit its realization. This study aimed to explore how residents experience and make use of personalized training elements within a program that combined fixed outcomes with open, personalized program components.
Methode:
We conducted a qualitative interview study using semi-structured interviews and template analysis. The study was situated in the Dutch national Obstetrics and Gynecology residency program, which includes a formally embedded, non-assessed training component with open-ended learning goals. We interviewed 12 residents and discussed their portfolios. Ethical approval was granted by the ERB of NVMO (NVMO-ERB 2024.2.13).
Resultaten (en conclusie):
All participants engaged with personalized components. The level of engagement varied and depended on variety in program director support, workplace possibilities and both personal and professional interest. Three interacting factors enabled this: 1) formal program structure legitimized and fostered engagement; 2) time and workplace exposure allowed participants to recognize personally meaningful goals; 3) program directors’ support facilitated engagement. Program directors varied in their guidance: some coached, endorsed, or role-modeled; others merely monitored activity; and a few did neither. Although the personalized components were not part of the assessment program, participants engaged with them, and indicated they were often motivated by personal interest, values, or moral dilemmas.
<b>Conclusion:</b>
Structured autonomy, workplace exposure and personal motivation can support personalized learning in CBME. Personalization requires intentional design, supportive structures, and coaching attuned to the individual learner.
Discussie (beschouwing resultaten en conclusie in het kader van de theorie):
This study explored obstetrics and gynecology residents’ experiences with personalization through development tracks in their CBME program. Although assessment is often considered the main driver of learning, residents engaged meaningfully in these tracks despite absence of assessment. Their motivation was shaped by clinical experiences, personal values, and moral dilemmas, aligning with literature on workplace-based learning that emphasizes continuous implicit and explicit learning, such as self-directed learning and transformative learning. A key mechanism was “structured autonomy”: freedom to select and pursue topics within a supported framework, resonating with calls to move beyond rigid, outcome-driven CBME structures. Several residents described transformative learning processes consistent with Mezirow’s model, reconsidering assumptions and professional roles. The context was important, since the Dutch Obstetrics and gynaecology program has over 20 years of iterative CBME implementation supported by sustained faculty development, educational leadership, and a national quality assurance system. Our findings suggest that combining EPAs with open personalized spaces, can foster autonomy, reflection, and transformation.
Practice points
EPA’s are essential, but not the full story: Combine clearly defined EPAs with space for broader, personalized learning.
Allow time for exposure and growth: Ensure early training focuses on clinical expertise, with time to encounter diverse situations that later prompt deeper, personal engagement with development tracks.
Avoid over-structuring with assessment: Create learning spaces without checklists or summative assessment.
Open-ended goals can work alongside EPAs: Provide examples and role models to guide residents in navigating these more abstract domains.
Coaching is not one-size-fits-all: Support program directors in tailoring their coaching.
Referenties:
de Heer MH, Driessen EW, Teunissen PW, Scheele F. Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans. Frontiers in Medicine. 2024;11.
Scheele F, Van Luijk S, Mulder H, Baane C, Rooyen CD, De Hoog M, et al. Is the modernisation of postgraduate medical training in the Netherlands successful? Views of the NVMO Special Interest Group on Postgraduate Medical Education. Med Teach. 2014;36(2):116-20.