Cross-disciplinary “General Learning Objectives” for postgraduate medical training: Prioritisation of five competency domains using a Delphi process

Objective: The Swiss postgraduate education regulations stipulate that teaching be guided by cross-disciplinary “General Learning Objectives” (GLOs) based on the CanMEDS roles. Notwithstanding these regulations, teaching activities and performance criteria for GLOs are scarcely evident in postgraduate training programmes. The primary aim of this study was to determine the reasons why too little emphasis is placed on GLOs in postgraduate training programmes. A secondary aim was to define a reduced set of needs-based cross-disciplinary competencies that trainees should develop during their postgraduate medical training. Methodology: A Delphi study was conducted to survey postgraduate trainees and heads of training centres throughout Switzerland. In two rounds of surveys, data were collected on (1) why too little emphasis is placed on GLOs in postgraduate training and (2) which GLOs are considered relevant. Based on these results, the GLOs were then consolidated into competency domains. Results: The main reason for the underemphasis on GLOs was the high workload of postgraduate trainees. Based on the data from both survey rounds, the following five competency domains were formulated and prioritised by the research team: “patient safety”, “communication in physician-patient relationships”, “mental health of physicians”, “collaboration in interprofessional teams” and “clinical ethics”. Conclusions: The results of the Delphi study confirm the need for action and provide important insights into how sub-aspects of GLOs are weighted by clinicians. Barriers to implementation of GLOs include the high workload imposed on postgraduate trainees and the lack of awareness about GLOs. The final concept comprised five cross-disciplinary competency domains that provide an application-oriented framework to underpin postgraduate medical training.