BACKGROUND Competency-based medical education (CBME) addresses the accountability of postgraduate training programmes to graduate specialists capable of independent practice. METHODS We undertook a systematic review and narrative synthesis of the published CBME literature in anaesthesia training programmes to identify current practices and areas requiring further exploration. RESULTS We grouped the 23 studies that met our inclusion criteria into the following categories: demonstrating outcomes of CBME, developing a consensus on an achievable CBME curriculum, CBME curriculum framework, design and implementation of workplace-based assessment (WBA) tools, trainee self-assessment, perceptions of trainees and supervisors on WBA tools, and technological solutions for assessment and feedback. Included studies reported variable success in reaching consensus in competency outcome frameworks for sequenced progression and limited research on approaches to curriculum delivery, whilst the majority of studies focused on workplace assessment. Studies supported the use of entrustment scales, where assessors make a judgement on the extent to which the trainee can manage a case independently. While evidence supported the reliability of WBA tools, and predicted the numbers needed for high-stakes decisions, areas of concern related to factors influencing the value WBA tools in promoting trainee learning, and variable perceptions of their value in making decisions on progression. CONCLUSIONS Evidence on outcomes of CBME was limited to acquisition of specific competencies during training. The large number of unanswered questions and the dearth of studies across the core components of CBME suggest that we need a collaborative approach to create the evidence required to implement CBME wisely and cost effectively, to have positive impacts on patients, trainees, and healthcare systems.

中文翻译：

---

麻醉中基于能力的医学教育的系统综述和叙述性综合。

背景技术基于能力的医学教育（CBME）解决了研究生培训计划对有独立实践能力的研究生专家的责任。方法我们对麻醉培训计划中已发表的CBME文献进行了系统的回顾和叙述性综合，以识别当前的做法和需要进一步探索的领域。结果我们将符合纳入标准的23项研究分为以下几类：展示CBME的成果，就可实现的CBME课程达成共识，CBME课程框架，基于工作场所评估（WBA）工具的设计和实施，受训者自我评估，学员和主管对WBA工具的看法以及评估和反馈的技术解决方案。纳入的研究报告说，在按顺序进行的能力结果框架达成共识方面取得了不同程度的成功，并且对课程交付方法的研究有限，而大多数研究则集中在工作场所评估上。研究支持委托量表的使用，其中评估者对受训者可以独立处理案件的程度做出判断。虽然有证据支持WBA工具的可靠性，并预测了高风险决策所需的数量，但关注的领域与影响WBA工具在促进学员学习中的价值的因素有关，以及在制定进度决策时对其价值的看法不一。结论关于CBME结果的证据仅限于在培训过程中获得特定能力。