title: The strategic role of competency based medical education in health care reform: a case report from a small scale, resource limited, Caribbean setting.
abstract: BACKGROUND
  Curaçao is a Dutch Caribbean island with a relatively high aging population, a high prevalence of chronic diseases and a health care system that is driven by cost-containment. In 2009 the development of a new value-based health care (VBHC) system was initiated on the island, and a key role was identified for the St. Elisabeth Hospital as a (model) platform for implementing this initiative. We therefore decided to investigate for the requirements needed to build a health care environment that is conducive for change and capable of facilitating the smooth migration of existent services into an effective and sustainable VBHC system.
  
  
  RESULTS
  Our findings revealed that our chosen approach was well accepted by the stakeholders. We discovered that in order to achieve a new value based health care system based on a reliable and well-organized system, the competencies of health care providers and the quality of the health care system needs to be assured. For this, extra focus needs to be given to improving service and manpower development both during and after formal training.
  
  
  CONCLUSIONS
  In order to achieve a VBHC system in a resource-limited environment, the standard of physicians' competencies and of the health care system need to be guaranteed. The quality of the educational process needs to be maintained and safeguarded within an integrated health care delivery system that offers support to all care delivery and teaching institutions within the community. Finally, collaborative efforts with international medical institutions are recommended.
authors.affiliation: Department of Pediatrics, Atrium Medical Center, Henri Dunantstraat 5, 6401 CX, Heerlen, Netherlands. j.busari@atriummc.nl.|Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands. j.busari@atriummc.nl.
authors.forename: Jamiu O
authors.initials: JO
authors.lastname: Busari
authors.affiliation: Department of Medical Education, St. Elisabeth Hospital, Willemstad, Curaçao. ajduits@gmail.com.|Institute for Medical Education, University Medical Center Groningen, Groningen, the Netherlands. ajduits@gmail.com.|Red Cross Blood bank Foundation, Willemstad, Curaçao. ajduits@gmail.com.
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Duits
mesh_terms: D017691:Caribbean Region; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D004501:Education, Medical / Q000458:organization & administration*; D018166:Health Care Reform / Q000458:organization & administration*; D006295:Health Resources / Q000191:economics*; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D009426:Netherlands; D000078329:Workforce