Differences in the Assessed Performance of Medical Interns in a Comparison of Competency-based and Subject-based Curricula: a Qualitative Study

Abstract Background: An internship is a transitional training period a medical school graduate undertakes prior to attaining full registration as a medical doctor. Numerous studies have shone a light on the unpreparedness of medical school graduates for the realities of medical practice. Implementation of a competency-based curriculum (CBC) is thought to produce better prepared medical graduates because this curriculum is more structured and integrated; moreover, learning outcomes, the learning process, and assessment are better aligned in the cognitive, affective, and psychomotor domains. During 2006–2011, Indonesia conducted a nation-wide reform shifting to a CBC from a subject-based curriculum (SBC) and launched an internship program in 2013. This study aimed to compare the performances of medical interns training under these two different curricula. Methods: This study was conducted in Yogyakarta Province, involving six supervisors and six interns from six different types of district hospitals. Qualitative, semi-structured interview methods, and thematic analysis were applied. Results: In total, 1,296 initial codings were identified and grouped under the following topics: overall experience (327), effective communication (97), scientific foundation (47), clinical skills (48), information management (23), management of health problems (194), self-insight and professional development (351), and professionalism (209). Eighteen themes emerged, namely understanding the internship, authority, practice context, interprofessional communication, patient communication, cultural awareness in communication, gap and fulfillment in clinical skills, knowledge gap and enhanced knowledge, assumption of a General Practitioner role, progression to profiency, information literacy, internal motivation, learning opportunities, constructive feedback, transition, and working culture. There were irregular patterns of performance from both of the CBC and SBC interns. Interestingly, compared with the SBC group, the CBC group revealed less confidence and assertiveness in handling patients. This group also lacked communication skills when interacting with nurses and patients alike. Moreover, the SBC group demonstrated the ability to learn and adapt quickly to the working environment. Neither group paid much attention to information literacy. Conclusion: We cannot conclude that a CBC would yield better prepared medical graduates. The results of this study showed irregular patterns in eight areas. Hospital contexts and variation in the characters of interns might have contributed to this irregularity. More exposure to the working context and greater contributions from the healthcare system are recommended in the medical curriculum, whether it be a CBC or a SBC. WC:338