• Vol. 43 No. 11, 544–549
  • 15 November 2014

When Traditional Model Meets Competencies in Singapore: Beyond Conflict Resolution

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ABSTRACT

Introduction: The implementation of competency-based internal medicine (IM) residency programme that focused on the assurance of a set of 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies in Singapore marked a dramatic departure from the traditional process-based curriculum. The transition ignited debates within the local IM community about the relative merits of the traditional versus competency-based models of medical education, as well as the feasibility of locally implementing a training structure that originated from a very different healthcare landscape. At the same time, it provided a setting for a natural experiment on how a rapid integration of 2 different training models could be achieved.

Materials and Methods: Our department reconciled the conflicts by systematically examining the existing training structure and critically evaluating the 2 educational models to develop a new training curriculum aligned with institutional mission values, national healthcare priorities and ACGME-International (ACGME-I) requirements.

Results: Graduate outcomes were conceptualised as competencies that were grouped into 3 broad areas: personal attributes, interaction with practice environment, and integration. These became the blueprint to guide curricular design and achieve alignment between outcomes, learning activities and assessments. The result was a novel competency-based IM residency programme that retained the strengths of the traditional training model and integrated the competencies with institutional values and the unique local practice environment.

Conclusion: We had learned from this unique experience that when 2 very different models of medical education clashed, the outcome may not be mere conflict resolution but also effective consolidation and transformation.


In 2010, graduate medical education in Singapore underwent major reform. With the implementation of competency-based residency programmes, hospitals in Singapore became the first outside the United States (US) to adopt a training structure based on the Accreditation Council for Graduate Medical Education (ACGME) core competencies and seek accreditation by the same council. Internal medicine (IM) was one of the first 7 specialties that received a mandate from the Ministry of Health, Singapore (MOH) to redesign its postgraduate medical education (PGME) structure to meet the standards of the newly constituted ACGME-International (ACGME-I). This educational reform marked a dramatic departure from the traditional process-based curriculum in Singapore that emphasised content delivery (medical knowledge and patient care), and relied heavily on workplace-based global ratings and high stake summative assessments to ensure competence. The transition to a competency-based curriculum that focused on the assurance of a set of 6 core competencies presented major challenges to the participating institutions. The mandate ignited debates within the local IM community about the relative merits of the traditional versus competency-based models of medical education in ensuring that residents could provide high-quality medical care when they enter independent practice.

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