Educational Implications of a Tiered, Competency‐Based “Step Ladder System”

BACKGROUND: Aligning undergraduate and early postgraduate clinical training remains challenging. We evaluated a tiered competency checklist ("Step Ladder System") implemented in an obstetrics-gynecology (OBGYN) rotation using a mobile assessment platform. METHODS: We retrospectively analyzed 74 learners (41 final-year medical students, 33 first-year residents) who completed an OBGYN rotation at a Japanese university hospital (April 2022-November 2024). The Step Ladder System includes 93 workplace-based tasks across obstetrics, gynecology, and general practice, organized into three progressive steps (Steps 1-3). Outcomes were stepwise completion rates, gender differences, supervisor ratings, and app-recorded feedback. We also identified "seamless" tasks and "low-achievement" tasks to inform curriculum improvement. RESULTS: Students achieved higher completion than residents in Step 1 (82.4% vs. 73.2%, p < 0.05), similar completion in Step 2 (59.2% vs. 54.4%, ns), and lower completion in Step 3 (17.1% vs. 22.1%, p < 0.05). Female learners showed higher completion in several knowledge-focused Step 2 tasks, while a small number of procedural tasks favored males. Supervisor ratings were predominantly positive (4-5/5), supported by encouraging narrative comments. Ten "seamless" tasks (high completion in both groups with minimal between-group differences) indicated similar achievement patterns across learner groups, whereas "low-achievement" tasks (low completion across learners) clustered in advanced Step 3. CONCLUSIONS: A mobile, stepwise competency checklist provides a structured framework for clinical training and enables real time documentation and feedback. Completion data may serve as a curriculum diagnostic tool by highlighting stable competencies and potential gaps.