title: Facilitators and barriers to a nationwide implementation of competency-based postgraduate medical curricula: a qualitative study.
abstract: BACKGROUND
  Postgraduate medical education (PGME) curricula are being redesigned across the western world.
  
  
  OBJECTIVE
  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.
authors.affiliation: University of Groningen, Wenckebach Institute, University Medical Center Groningen, Postgraduate School of Medicine, Groningen, the Netherlands. e.jippes@umcg.nl
authors.forename: E
authors.initials: E
authors.lastname: Jippes
authors.forename: S J
authors.initials: SJ
authors.lastname: Van Luijk
authors.forename: J
authors.initials: J
authors.lastname: Pols
authors.forename: M C
authors.initials: MC
authors.lastname: Achterkamp
authors.forename: P L P
authors.initials: PL
authors.lastname: Brand
authors.forename: J M L
authors.initials: JM
authors.lastname: Van Engelen
mesh_terms: D003162:Competency-Based Education; D004059:Diffusion of Innovation; D004503:Education, Medical, Graduate / Q000379:methods*; D006176:Gynecology / Q000193:education; D006801:Humans; D009426:Netherlands; D009774:Obstetrics / Q000193:education; D010372:Pediatrics / Q000193:education; D036301:Qualitative Research