How competency-based education solves hospitals’ economic dilemma
A recent episode of the Swiss TV program “Kassensturz” shed light on a central weakness in medical training: the growing conflict between hospitals’ financial pressures and the need for high-quality practical education for surgical residents.
The report paints a worrying picture: residents spend much of their time on administrative tasks, while essential time in the operating room — the very core of their craft — is lacking. Hospitals face a double bind: they depend on residents’ labor, yet providing meaningful operative training is both time-consuming and costly.
This system has become critically inefficient.
But there is a proven way out of this dilemma — a paradigm shift toward competency-based medical education (CBME).
The problem: Procedure counts don’t build competence
The traditional model is built on time and quantity. Surgical logbooks, requiring a specific number of procedures, remain the main measure of training progress.
However, this approach has one major flaw:
- It does not measure actual competence.
- A full logbook does not guarantee that a doctor can perform a procedure independently and safely.
The solution: From counting cases to assessing entrustability
Competency-based education asks a simple but transformative question:
Not “How long was someone present?” or “How often has someone done this?”
but rather: “Can this learner truly be entrusted to perform this task independently?”
The foundation of this approach lies in Entrustable Professional Activities (EPAs).
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What is an EPA? An EPA is a clearly defined professional activity (for example, performing an inguinal hernia repair) that a trainee is progressively entrusted with once they have demonstrated sufficient competence.
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The focus: instead of counting procedures, the degree of readiness for independent practice becomes the key measure of progress. This is documented through frequent, workplace-based assessments and meaningful, brief feedback conversations.
How EPAs address the economic challenge
Transitioning to CBME and EPAs is not only a pedagogical improvement — it’s also a strategic response to economic pressure.
- Efficient Allocation of Resources
By documenting each trainee’s actual entrustability and level of independence, supervision can be targeted precisely where it’s needed.
Senior physicians no longer have to oversee tasks that trainees already master. On the contrary, entrusting these activities to competent trainees is both motivating and relieving for the team.
- Flexible and Proven Cost Efficiency
The experience from the Netherlands demonstrates this potential clearly.
Faced with budget cuts, the country reformed its postgraduate medical training based on CBME principles.
The result: the average training duration decreased by around three months (Source) — without compromising quality. This translated into annual savings of 25 to 30 million euros, while maintaining a high standard of training.
Conclusion: A strategic path forward
Kassensturz exposed the symptoms of an outdated system.
The solution is not to pour more money into inefficient structures, but to modernize the system itself.
Competency-based education with EPAs provides the strategic lever to resolve the tension between educational quality and economic reality.
It makes competence visible, promotes the efficient use of resources, and ensures that tomorrow’s specialists are not only formally qualified — but genuinely ready for practice.
