Uncommon Places - Joseph Schwab and the Development of Competency-Based Medical Education
Abstract
This study investigates the unintended consequences of the Royal College's transition to Competence by Design (CBD), a competency-based curriculum in postgraduate medical education. A secondary qualitative analysis using Joseph Schwab’s ‘curriculum commonplaces’ was applied to a data set of interviews with CBD implementation leads across Canada to identify the roles of key actors in the process of curriculum making. Findings demonstrate misalignments that emerged between values and enactment when the needs of teachers, learners and milieu were initially underestimated in design and early implementation phases. These misalignments disconnected assessment practices from experiences of teaching, learning and entrustment. The study contributes an understanding of the sources of unintended consequences and potential resolution through a more thoughtful coordination of curriculum development to inform continued adaptations to ‘CBD 2.0’ as it continues to evolve through the process envisioned by the Royal College.