Breeding Ground for Paradoxes: Implementing a Competency-Based Medical Education Fellowship Program

Despite its increasing popularity over the past decade as an improved training model, literature evaluating Competency Based Medical Education (CBME) implementation processes is scarce. We used an action research methodology to observe and analyze the implementation processes of a CBME fellowship program in Neonatology wards in hospitals in Israel. Our data revealed that the challenges emerging during the implementation process can be framed as paradoxes and that CBME entails a new category of paradoxes beyond those previously reported in the literature (i.e., role-paradox). In addition, we developed a CBME implementation model that suggests a dynamic process including three paradox-driven circular courses; 1) a direct loop between CBME implementation and the exposure to paradoxes, 2) an indirect loop between exposure to paradoxes and the formation of a paradox mindset, that in turn further enhances CBME implementation, and 3) an indirect loop between the paradox mindset of the individual and the development of a ward level paradox climate. Propositions regarding the suggested model, and the associated individual and organizational level outcomes of the successful implementation of a CBME program are suggested.