A Scoping Review and Realist Synthesis of Surgical Trainees' Perspectives in Competency-based Training.

Abstract

To summarize the literature pertaining to surgical trainees' experiences with competency-based medical education (CBME), outline strengths and weaknesses, and synthesize the evidence to map the sequence of activities that must be successfully implemented for CBME to function effectively. CBME has seen rapid and widespread adoption in surgical training programs globally. Amid reports of mixed findings for how CBME programs impact trainees' wellness, program directors require evidence-informed solutions. A scoping literature review of Medline, Embase, ERIC, PsycINFO, and the grey literature was conducted between January 1, 2012 and August 9, 2024 for studies reporting surgical trainees' perceptions of advantages and disadvantages of CBME. The data was synthesized with reflexive thematic analysis, and from a scientific realism perspective to generate a conceptual map of how themes relate to the intended program theory of CBME. 2160 titles were identified. After title and abstract screening, 1933 studies were excluded, leaving 227 articles for full-text review of which 213 were excluded. Reported advantages and disadvantages of CBME organized into four themes: logistics of implementation, educational value, infectious apathy, and psychological implications. A series of program theories are proposed and mapped to the themes, providing a contextualized understanding of how the intended impact of CBME on trainees has differed from reality. By mapping themes and proposing related program theories, we provide surgical programs in different contexts a guide to fine-tune ongoing CBME implementation processes. We believe such refinements will enhance resident well-being, while promoting the goal of creating safe, capable surgeons.