Unveiling the paradoxes of implementing post graduate competency based medical education programs

Noa A. Birman, Dana R. Vashdi, Rotem Miller-Mor Atias, Arieh Riskin, Shmuel Zangen, Ita Litmanovitz, Doron Sagi

Research output: Contribution to journalArticlepeer-review


Purpose: Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation. Method: A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards. Results: Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators. Conclusions: Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.

Original languageEnglish
Number of pages8
JournalMedical Teacher
Early online date28 May 2024
StateE-pub ahead of print - 28 May 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2024 Informa UK Limited, trading as Taylor & Francis Group.


  • Competency-based medical education
  • organizational change in healthcare education
  • paradox theory
  • post graduate medical education

ASJC Scopus subject areas

  • Education


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